Dimopoulos M A, Fernandez J F, Samaan N A, Holoye P Y, Vassilopoulou-Sellin R
Department of Medical Oncology, University of Texas M. D. Anderson Cancer Center, Houston 77030.
Cancer. 1992 Jan 1;69(1):66-71. doi: 10.1002/1097-0142(19920101)69:1<66::aid-cncr2820690113>3.0.co;2-2.
The potential role of paraneoplastic Cushing's syndrome (CS) was assessed on the clinical course of patients with small cell lung cancer. A retrospective comparison was done of complications and survival rates according to the presence or absence of CS in patients with small cell lung cancer who died within 90 days of initial administration of chemotherapy. The setting was a comprehensive cancer center. Eleven patients with clinical and/or biochemical features of CS were identified from among 90 patients who presented between 1979 and 1989 with previously untreated small cell lung cancer. The group with CS and the control patients were compared in terms of clinicopathologic prognostic factors, treatment, and outcome. Patients with CS were comparable to the control patients in all prognostic factors, including tumor stage and cancer treatment. Eighty-two percent of patients with CS (nine of 11) died within 14 days of initiation of chemotherapy compared with 25% of the control patients (19 of 77). The median survival from initiation of chemotherapy was 12 days for the 11 patients with CS and 27 days for the 77 control patients. In 45% of the patients with CS (five of 11), death was attributed to opportunistic fungal or protozoal infection compared with 8% of control patients (six of 77). Paraneoplastic CS is a previously unrecognized adverse prognostic factor for patients with small cell lung cancer. Those with both small cell lung cancer and CS have severe opportunistic infections soon after the initiation of chemotherapy, leading to clinical deterioration and death before antineoplastic benefit from chemotherapy can be achieved. Biochemical control of CS for at least 1 to 2 weeks before initiation of chemotherapy may ameliorate the poor prognosis.
对副肿瘤性库欣综合征（CS）在小细胞肺癌患者临床病程中的潜在作用进行了评估。对初始化疗后90天内死亡的小细胞肺癌患者，根据是否存在CS进行了并发症和生存率的回顾性比较。研究地点为一家综合癌症中心。在1979年至1989年间就诊的90例未经治疗的小细胞肺癌患者中，识别出11例具有CS临床和/或生化特征的患者。对CS组和对照组患者在临床病理预后因素、治疗及结局方面进行了比较。CS组患者在所有预后因素方面，包括肿瘤分期和癌症治疗，与对照组患者相当。82%的CS患者（11例中的9例）在化疗开始后14天内死亡，而对照组患者为25%（77例中的19例）。11例CS患者化疗开始后的中位生存期为12天，77例对照患者为27天。45%的CS患者（11例中的5例）死亡归因于机会性真菌或原虫感染，而对照组患者为8%（77例中的6例）。副肿瘤性CS是小细胞肺癌患者先前未被认识的不良预后因素。同时患有小细胞肺癌和CS的患者在化疗开始后不久即发生严重的机会性感染，导致临床病情恶化并在化疗取得抗肿瘤效果之前死亡。化疗开始前至少1至2周对CS进行生化控制可能改善不良预后。
