NEUROENDOCRINE DIFFERENTIATION AS A PROGNOSTIC FACTOR IN NONSMALL CELL LUNG-CANCER

The prognostic value of clinical and pathological factors in 97 patien ts with non-small cell lung cancer (NSCLC), were analyzed through immu nohistochemical methods. The impact on response rate and survival of a ge, Karnofsky performance status (PS), sex, NSCLC subtype and grade, e xtent of disease, objective chemotherapy response, LDH values, metasta tic sites involved and immunohistochemical markers of neuroendocrine d ifferentiation (neuron specific enolase (NSE), synaptophysin (Sy 38), chromogranin (Chr A) and Leu-7) were analyzed. Median age was 61 years and seven patients were women. Histologically, 58 had squamous cell c arcinoma, 28 adenocarcinoma and 11 large cell undifferentiated carcino ma. One patient had Stage II, 35 Stage IIIa, 19 Stage IIIb and 42 Stag e IV. Six patients achieved complete response, 18 partial response, 34 stable disease and 39 progressive disease. NSE was negative in 54.3% of cases as was Sy 38 (77.4%), Chr A (97.8%) and Leu-7 (95.8%). We hav e found correlation between neuroendocrine differentiation and absence of P-Glycoprotein expression; patients included in this subset had a higher response rate but no evidence of longer survival. The univariat e analysis showed that four parameters had significant adverse effect on survival: non-responders, poor PS, abnormal LDH value and absence o f NSE expression. Multivariate analysis showed that the best combinati on of independent prognostic factors in predicting survival was: PS an d NSE expression by immunohistochemical methods.