Paul Maddison1, Paul Gozzard2, Matthew J Grainge2, Bethan Lang2. 1. From the Department of Neurology (P.M.), Nottingham University Hospitals NHS Trust, Queen's Medical Centre; Division of Clinical Neuroscience (P.G.), University of Nottingham, Queen's Medical Centre; Department of Statistics (M.J.G.), University of Nottingham, Nottingham City Hospital; and Nuffield Department of Clinical Neurosciences (B.L.), University of Oxford, John Radcliffe Hospital, Oxford, UK. paul.maddison@nhs.net. 2. From the Department of Neurology (P.M.), Nottingham University Hospitals NHS Trust, Queen's Medical Centre; Division of Clinical Neuroscience (P.G.), University of Nottingham, Queen's Medical Centre; Department of Statistics (M.J.G.), University of Nottingham, Nottingham City Hospital; and Nuffield Department of Clinical Neurosciences (B.L.), University of Oxford, John Radcliffe Hospital, Oxford, UK.
Abstract
OBJECTIVE: To establish whether improved tumor survival in patients with Lambert-Eaton myasthenic syndrome (LEMS) and small-cell lung cancer (SCLC) was due to known prognostic risk factors or an effect of LEMS independently, perhaps as a result of circulating factors. METHODS: We undertook a prospective observational cohort study of patients with LEMS attending Nottingham University Hospitals, UK, or via the British Neurological Surveillance Unit. In parallel, patients with a new diagnosis of biopsy-proven SCLC were enrolled, examined for neurologic illness, and followed up until death or study end. RESULTS: Between May 2005 and November 2014, we recruited 31 patients with LEMS and SCLC and 279 patients with SCLC without neurologic illness. Allowing for known SCLC survival prognostic factors of disease extent, age, sex, performance status, and sodium values, multivariate Cox regression analysis showed that the presence of LEMS with SCLC conferred a significant survival advantage independently of the other prognostic variables (hazard ratio 1.756, 95% confidence interval 1.137-2.709, p = 0.011). CONCLUSIONS: Improved SCLC tumor survival seen in patients with LEMS and SCLC may not be due solely to lead time bias, given that survival advantage remains after allowing for other prognostic factors and that the same degree of survival advantage is not seen in patients with paraneoplastic neurologic syndromes other than LEMS presenting before SCLC diagnosis.
OBJECTIVE: To establish whether improved tumor survival in patients with Lambert-Eaton myasthenic syndrome (LEMS) and small-cell lung cancer (SCLC) was due to known prognostic risk factors or an effect of LEMS independently, perhaps as a result of circulating factors. METHODS: We undertook a prospective observational cohort study of patients with LEMS attending Nottingham University Hospitals, UK, or via the British Neurological Surveillance Unit. In parallel, patients with a new diagnosis of biopsy-proven SCLC were enrolled, examined for neurologic illness, and followed up until death or study end. RESULTS: Between May 2005 and November 2014, we recruited 31 patients with LEMS and SCLC and 279 patients with SCLC without neurologic illness. Allowing for known SCLC survival prognostic factors of disease extent, age, sex, performance status, and sodium values, multivariate Cox regression analysis showed that the presence of LEMS with SCLC conferred a significant survival advantage independently of the other prognostic variables (hazard ratio 1.756, 95% confidence interval 1.137-2.709, p = 0.011). CONCLUSIONS: Improved SCLC tumor survival seen in patients with LEMS and SCLC may not be due solely to lead time bias, given that survival advantage remains after allowing for other prognostic factors and that the same degree of survival advantage is not seen in patients with paraneoplastic neurologic syndromes other than LEMS presenting before SCLC diagnosis.
Authors: Wade T Iams; Eileen Shiuan; Catherine B Meador; Marc Roth; Jennifer Bordeaux; Christine Vaupel; Kelli L Boyd; IlaSri B Summitt; Lucy L Wang; Joseph T Schneider; Jeremy L Warner; Zhiguo Zhao; Christine M Lovly Journal: J Thorac Oncol Date: 2019-06-12 Impact factor: 15.609