Introduction and aims: To analyze the characteristics and long-term survival of patients diagnosed with lung cancer (LC), small cell and non small cell, in our hospital. Patients and methods: Retrospective study of patients with a cytohistological diagnosis of LC between 1999 and 2004. Survival was estimated using the Kaplan-Meier method. The chi-squared test was used to assess possible associations between different variables. Results: In this time period, 996 cases were diagnosed, 85.6% in males and 14.4% in females. A total of 80.6% of the patients were smokers. Squamous cell carcinoma was the most frequent in males and adenocarcinoma in females; 20.4% of the tumours were at an early stage (I and II) at the time of diagnosis and only 16.8% were amenable to surgery. Overall survival was 7.9% at 5 years and the LC-specific survival was 14%. Survival was significantly worse in advanced stages and in patients that did not receive active treatment. Conclusions: Overall 5-year survival in our series was low, but similar to that described in other Spanish registries. This may be related to the low number of patients diagnosed in early stages and who could be treated surgically.

Important advances in non small cell lung cancer (NSCLC) diagnosis, staging and treatment have been made over the last decade. Minimally-invasive endoscopic techniques including endobronchial ultrasound guided transbronchial needle aspiration (EBUS-TBNA) and navigational bronchoscopy have emerged as valid alternatives to transthoracic and/or surgical approaches, providing aspiration cytology material instead of histological material for diagnosis and staging of mediastinal and lung lesions. Several drugs designed to target molecular pathways involved in cancer-cell growth and survival have been shown to be effective in a selected fraction of NSCLC patients, mostly with adenocarcinoma (targeted therapy). Somatic activating mutations in several genes involved in those pathways (EGFR/KRAS) can predict patients’ responses to targeted therapies (individualized therapy). Those mutations are commonly detected in histopathological samples (core-needle biopsy/surgical resection). However, when histological tissues are not available, molecular testing can be performed on cytological specimens. This scenario is increasing in frequency, due to the use of less invasive procedure for diagnosis and staging such EBUS-TBNA and/or patients in advanced stage of disease who are not candidates for surgery. Several strategies exist and may be combined to ensure that the less abundant material that results from minimally invasive techniques can be used efficiently for molecular analyses. These include Rapid On-Site Evaluation (ROSE) of EBUS-TBNA cytological material, to ensure optimal sampling and triage of the material (e.g. cell-block preparation), and microdissection techniques, to select an adequate population of tumor cells. Major issues raised by cytological diagnosis of NSCLC and molecular testing on cytological specimen are discussed in this article.

To date, the treatment outcome of non small cell lung cancer (NSCLC) is still not satisfactory and new treatment options are urgently needed. The present study was designed to: 1) evaluate the effects of the antiangiogenic drug; nimesulide (NSAID, a COX-2 inhibitor) combined with chemotherapy on NSCLC treatment progress, 2) Evaluate the role of vascular endothelial growth factor (VEGF) and basic fibroblast growth factor (bFGF), as prognostic indicators in NSCLC, 3) Correlate the above parameters levels with the clinicopathological status of the patients during the therapy. The study included 30 NSCLC. The patients were divided to: group I, included 17 patients received chemotherapy alone and group II included 13 patients received the same chemotherapy with Nimesulide and 10 as controls. Serum and biopsies were taken for all subjects on admission and 3 weeks after the completion of treatment. Results: serum and tissue levels of VEGF and bFGF, were significantly higher in NSCLC patients and decreased significantly after treatment specially in group II compared to group I. The serum and tissue levels of the studied parameters decreased significantly in the responders as compared to resistant cases. The response rate after combined therapy was 69% versus 53% after chemotherapy alone. In conclusion, Nimesulide appears to boost the efficacy of the traditional chemotherapy as its co-administration showed encouraging effects on improving and normalization of the proangiogenic parameters levels and in turn the vascular supply of tumors. This may have good impact on the patient outcome, prolongation of their survival rate and prognosis.