1. Rev Mal Respir. 2009 Jan;26(1):37-44. KBP2000-articles [Five year survival for lung cancer patients managed in general hospitals] Grivaux M, Zureik M, Marsal L, Asselain B, Peureux M, Chavaillon JM, Prud'homme A, Carbonnelle M, Goarant E, Maury B, Bedossa A, Blanchon F. Service de Pneumologie, Hôpital de Meaux, France. INTRODUCTION: In 2000 the College of Pulmonologists of General Hospitals undertook an epidemiological study (KBP-2000-CPHG) enrolling all new cases of histologically confirmed lung cancer managed in general hospitals. This paper reports the five year survival in these cases. METHODS: Vital status was available for 5447 out of 5667 patients included in the original study. The effect of different prognostic factors on mortality was assessed. RESULTS: At 5 years 567 patients (10.4%) were still alive. Median survival for the 4880 (89.6%) deceased patients was 7 months. Univariate analysis identified age, smoking history, performance status, histological type and disease stage (TMN classification) as determinants of survival. For non-small cell lung cancer (n=4885) multivariate analysis identified five predictive factors for mortality - age, gender histological type, performance status and stage. CONCLUSIONS: Five year survival in lung cancer continues to be poor. As the risk factors for poor outcome at the time of diagnosis are not modifiable and pending the results of screening studies reduction in mortality must rest on primary prevention. PMID: 19212288 [PubMed - indexed for MEDLINE] 2. Lancet Oncol. 2006 Oct;7(10):829-36. 4-year mortality in patients with non-small-cell lung cancer: development and validation of a prognostic index. Blanchon F, Grivaux M, Asselain B, Lebas FX, Orlando JP, Piquet J, Zureik M. Service de Pneumologie, Centre Hospitalier de Meaux, Meaux, France. Comment in: Lancet Oncol. 2006 Oct;7(10):789-90. BACKGROUND: Lung cancer is the commonest cause of death due to cancer in the world. Non-small-cell lung carcinoma (NSCLC) represents about 80% of overall lung cancer cases worldwide. An accurate predictive model of mortality in patients with NSCLC could be useful to clinicians, policy makers, and researchers involved in risk stratification. The objective of this study was to develop and validate a simple prognostic index for 4-year mortality in patients with NSCLC by use of information obtained at the time of lung cancer diagnosis. METHODS: In 2000, 4669 patients with histologically or cytologically proven NSCLC were enrolled prospectively from 137 pneumology departments in French general hospitals. Patients not lost to follow-up (n=4479) were randomly assigned to the development cohort (n=2979) or the validation cohort (n=1500). Every patient's physician completed a standard and anonymous questionnaire. We used a Cox model to identify variables independently associated with mortality and weighted the variables to create a prognostic index. FINDINGS: Median follow-up for survivors was 49 months (IQR 46-51). There were 2585 deaths (87%) in the development cohort and 1310 deaths (87%) in the validation cohort. Five independent predictors of mortality Page 1
were identified: age (>70 years, 1 point); sex (male, 1 point); performance status at diagnosis (reduced activity, 3 points; active >50%, 5 points; inactive >50%, 8 points; and total incapacity, 10 points); histological type (large-cell carcinoma, 2 points); and tumour-node-metastasis (TNM) staging system (IIA or IIB, 3 points; IIIA or IIIB, 6 points; and IV, 8 points). The minimum and maximum possible point scores were 0 and 22, respectively. Scores of the prognostic index were strongly associated with 4-year mortality in the development cohort: 0-1 points predicted a 35% (95% CI 28-43) risk, 2-4 points a 59% (52-66) risk, 5-7 points a 77% (72-81) risk, 8-10 points an 88% (85-90) risk, 11-14 points a 97% (96-98) risk, and 15-22 points a 99% (97-100) risk. The corresponding percentages in the validation cohort were 36% (24-47), 60% (50-70), 77% (71-83), 89% (86-93), 96% (95-98), and 99% (98-100), respectively. The prognostic index showed good discrimination, with mean bootstrap c statistics of 0.85 (95% CI 0.84-0.86) in the development cohort and 0.86 (95% CI 0.85-0.87) in the validation cohort. INTERPRETATION: This prognostic index, incorporating personal, tumour, and functional information would be helpful in guiding patient management, resource use, and the design of clinical trials. PMID: 17012045 [PubMed - indexed for MEDLINE] 3. Rev Mal Respir. 2006 Apr;23(2 Pt 1):165-71. [Cohort KBP-2000-CPHG: Evaluation of factors influencing survival in lung cancer] Blanchon F, Grivaux M, Zureik M, Marsal L, Asselain B, Lebas FX, Orlando JP, Steenhouwer F, Benichou-Flurin M, Coëtmeur D, Collon T, David P, Delclaux B, Piquet J. Service de pneumologie, Hôpital de Meaux, France. f-blanchon@ch-meaux.fr Comment in: Rev Mal Respir. 2006 Apr;23(2 Pt 1):115-6. INTRODUCTION: Lung cancer continues to have a poor prognosis despite some therapeutic advances. BACKGROUND: The last fifteen years has seen a dramatic increase in the incidence of lung cancer in women and an increased proportion of adenocarcinomas in both sexes. A study of overall survival as a function of gender and other prognostic factors has been established using the cohort of patients from the study KBP-2000-CPHG. METHODS: KBP-2000-CPHG is an epidemiological study carried out throughout the year 2000 looking at histologically confirmed primary lung cancers managed in general hospitals. 5,667 patients have been included. The study of survival looks at 2 and 5-year outcomes. The date and cause of death are recorded for each patient. In the absence of these data the date of the last contact is noted. If this is less than 4 months the patient is considered to be alive. If more than four months have elapsed a graduated strategy for establishing vital status is pursued which involves reviewing records from various different sources. RESULTS AWAITED: A preliminary review of the data was undertaken between September 2004 and March 2005 which obtained data on 5 567 patients. The analysis of survival according to sex and other forecast prognostic factors is underway. PMID: 16788443 [PubMed - indexed for MEDLINE] 4. Rev Mal Respir. 2004 Nov;21(5 Pt 3):8S70-8. Page 2
[Primary lung cancer in elderly subjects in France] Piquet J, Blanchon F, Grivaux M, Collon T, Zureik M, Barbieux H, Bénichou-Flurin M, Breton JL, Coëtmeur D, Delclaux B, Braun D, Homasson JP, Mouysset F, Riou R, le Poulain-Doubliez M, Marsal L; CPHG. Hôpital, Le Raincy-Montfermeil, France. INTRODUCTION: There are few data on primary bronchial carcinoma in France. We report here the results of the study KBP 2000-CPHG in which there were 1868 patients aged 70 or more and 338 aged 80 or more. METHODS: We compared the patients under 70 (Group I) with those aged 70 or more (Group II) as well as with the details of the over 80's. RESULTS: Group II included significantly more women (17.4% vs 15.2%; p = 0.04), non-smokers (11.2% vs 5.3%; p<0.0001), patients of poor performance status (24.2% vs 14.5%; p<0.0001) and squamous carcinomas (44.5% vs 37.8%; p<0.001) than Group I, but fewer adenocarcinomas (27.2% vs 31.5%; p = 0.009) and as many small cell carcinomas (15.9% vs 16.9%; p = 0.32). In Group II there were less stage III and IV tumours (75.1% vs 78.1%; p = 0.0005) more symptomatic treatment (23.2% vs 6.1%) and radiotherapy alone (12.8% vs 3.8%; p < 0.0001). The results were similar beyond 80 years. On multivariate analysis age, performance status and stage appeared to be independent variables in the choice of curative or symptomatic treatment. CONCLUSIONS: Age alone is not therefore a limiting factor in the choice of treatment. PMID: 15803540 [PubMed - indexed for MEDLINE] 5. Rev Pneumol Clin. 2004 Dec;60(6 Pt 1):333-43. [Primary non-small-cell lung cancer: analysis of 419 T1 (<or=3 cm) tumors in the KBP-2000-CPHG study] Collon T, Ba O, Grivaux M, Dore P, Azarian R, Orion B, Boyer J, Raffy O, Jourdain B, Beraud A, Paillot N, Jouveshomme S, Mordacque C, Zureik M, Marsal L, Piquet J, Blanchon F; CPHG. Hôpital Le Raincy-Montfermeil, Paris. T1 tumors have the best prognosis among primary non-small-cell lung cancers, basically because surgery is generally possible. Among 5.667 patients with primary lung cancer included in the KBP-2000-CPHG study, we examined the characteristics of 419 T1 tumors, i.e. 9.2% of the non-small-cell cancers. Compared with the group of patients with non-t1 tumors, patients with T1 tumors were younger (p=0.0007). They had an equivalent percentage of squamous-cell tumors but more adenocarcinomas (40.3% versus 35.5%, p=0.05). TNM staging showed that 27.6% of the T1 tumors were metastatic at diagnosis (stage IV) with 12.4% T1N0M1 nad 15.2% T1N1-3M1. For the M0 tumors, 52.2% were T1N0 (stage IA) and 20.1% were T1N1-3. Squamous-cell tumors were significantly more frequent among the T1M1 tumors (p=0.07). More than one quarter (27.6%) of the T1 tumors were in stage IV, pointing out the importance of the initial work-up. This findings suggests we should revisit strategies in order to take into account new Page 3
diagnostic possibilities. Likewise for the therapeutic strategy. Combinations using chemotherapy, surgery and radiotherapy should be better defined for this group of tumors. PMID: 15699906 [PubMed - indexed for MEDLINE] 6. Lung Cancer. 2004 Sep;45(3):279-87. Lung cancer among women in France. Analysis of the 904 French women with lung cancer included in the KBP-2000-CPHG study of the French College of General Hospital-based Pneumologists (CPHG). Grivaux M, Breton JL, Bombaron P, Kuntz P, Lebas FX, Mehdaoui A, Herman D, David P, Berruchon J, Delclaux B, Zureik M, Blanchon F; French College of General Hospital-based Pneumologists. Department of Pneumology, Meaux Hospital, 6-8, rue Saint Fiacre, BP 218, 77108 Meaux cedex, France. m-grivaux@ch-meaux.fr As the incidence of primary lung cancer in women seems to be increasing in parallel with that of smoking, we conducted an exhaustive epidemiological study in 137 hospitals in 2000. We identified 904 women with proven primary lung cancer (mean age 63.9 years), many of whom have never smoked (32.3%), particularly in cases of adenocarcinoma (43.4%). Small cell cancer accounted for 16.1% of cases. Adenocarcinomas were the most frequent (45.3%) of the non-small cell lung cancer (NSCLC), followed by squamous cell (23.4%), large cell (11.6%) and bronchoalveolar (1.9%) carcinomas. About one third (32.2%) of NSCLC were stage III and 48.1% were stage IV. Over half of all adenocarcinomas were stage IV. According to multivariate analysis, adenocarcinoma is related to less smoking and younger age. In conclusion, many women affected by lung cancer have never smoked. Adenocarcinoma appears to be the most frequent form and more often at a metastatic stage. PMID: 15301868 [PubMed - indexed for MEDLINE] 7. Rev Pneumol Clin. 2003 Nov;59(5 Pt 2):S56-8. [Lung cancer among French women in 2000: results of an epidemiological study (KBP-2000)] Blanchon F, Grivaux M, Breton JL. Service de Pneumologie, CHG de Meaux, 6, rue Saint-Fiacre, 77104 Meaux. PMID: 14707919 [PubMed - indexed for MEDLINE] 8. Rev Mal Respir. 2003 Nov;20(5 Pt 1):691-9. [Primary bronchial carcinoma in elderly subjects in France] Piquet J, Blanchon F, Grivaux M, Collon T, Zureik M, Barbieux H, Bénichou-Flurin M, Breton JL, Coëtmeur D, Delclaux B, Braun D, Homasson JP, Mouysset F, Riou R, le Poulain-Doubliez M, Marsal L; CPHG. Page 4
Hôpital, Le Raincy-Montfermeil, France. INTRODUCTION: There are few data on primary bronchial carcinoma in France. We report here the results of the study KBP 2000-CPHG in which there were 1868 patients aged 70 or more and 338 aged 80 or more. METHODS: We compared the patients under 70 (Group I) with those aged 70 or more (Group II) as well as with the details of the over 80's. RESULTS: Group II included significantly more women (17.4% vs 15.2%; p=0.04), non-smokers (11.2% vs 5.3%; p<0.0001), patients of poor performance status (24.2% vs 14.5%; p<0.0001) and squamous carcinomas (44.5% vs 37.8%; p<0.001) than Group I, but fewer adenocarcinomas (27.2% vs 31.5%; p=0.009) and as many small cell carcinomas (15.9% vs 16.9%; p=0.32). In Group II there were less stage III and IV tumours (75.1% vs 78.1%; p=0.0005) more symptomatic treatment (23.2% vs 6.1%) and radiotherapy alone (12.8% vs 3.8%; p<0.0001). The results were similar beyond 80 years. On multivariate analysis age, performance status and stage appeared to be independent variables in the choice of curative or symptomatic treatment. CONCLUSIONS: Age alone is not therefore a limiting factor in the choice of treatment. PMID: 14631248 [PubMed - indexed for MEDLINE] 9. Rev Mal Respir. 2002 Dec;19(6):727-34. [Epidemiologic of primary bronchial carcinoma management in the general French hospital centers] Blanchon F, Grivaux M, Collon T, Zureik M, Barbieux H, Bénichou-Flurin M, Breton JL, Coëtmeur D, Delclaux B, Asselain B, Piquet J. Hôpital de Meaux, Paris. f-blanchon@ch-meaux.fr INTRODUCTION: The College of General Hospital Respiratory Physicians have conducted a study aimed at a better understanding of the details and modalities of management of patients suffering from bronchial carcinoma in general hospitals in France. MATERIALS AND METHODS: A prospective epidemiological study was carried out on all the new cases of histologically proven bronchial carcinoma seen in general hospitals in the year 2000. The data were collected by a standardised questionnaire. RESULTS: 137 centres of investigation identified 5 667 patients, mean age 64.3 years, of whom 16% were women. 7.2% of patients were non smokers (with an incidence of 32.3% non-smokers among the women) and 40.3% were ex-smokers. Histologically 16.9% were small cell carcinomas, 40% squamous carcinomas (43.1% among the men, 23.4% among the women, p<0.0001), 30.1% adenocarcinomas (27.2% among the men, 45.3% among the women, p<0.0001). 77.1% of non small cell carcinomas were stages III and IV, and 66.8% of small cell carcinomas were disseminated, with no difference between the sexes. CONCLUSION: Respiratory physicians in general hospitals manage more than a quarter of the cases of bronchial carcinoma seen annually in France. The number of women affected is high with a significant percentage of non-smokers and adenocarcinomas. PMID: 12524492 [PubMed - indexed for MEDLINE] Page 5