Suzana Kukulj

203P: Could neutrophil-to-lymphocyte ratio be predictor of brain metastases in non small cell lung cancer?

Conclusions: Pleural effusion, opposite lung and bone are common sites of metastatic disease in NSCLC. Males, smokers had more lung metastases and females, non smokers had more pleural effusion and bone mets. There was no difference in metastatic pattern with respect to histology. Pleural effusion, liver and brain metastases significantly impacted survival Legal entity responsible for the study: Department of Medical Oncology, Nizam‘s Institute of Medical Sciences, Hyderabad Funding: Department of Medical Oncology, Nizam‘s Institute of Medical Sciences, Hyderabad Disclosure: All authors have declared no conflicts of interest.

Small cell lung cancer with solitary brain metastasis treated with complete resection

The common treatment modality for extensive‐stage small cell lung cancer is chemotherapy, which significantly improves survival in these patients. However, the median survival is still poor and usually does not reach 12 months. For a long time, surgery has not played any role in the treatment of small cell lung cancer. In recent years, the operative approach has been accepted as a form of treatment for patients with limited‐stage disease. However, in patients with resectable primary carcinoma and solitary metastasis, surgery is not recommended, although it is the standard method of treatment in patients with non‐small cell lung cancer and other malignancies. We report the long‐term survival of a patient with metastatic small cell lung cancer treated with complete resection of both the primary tumor and the solitary brain metastasis.

Prognostic value of lactates in relation to gas analysis and acid-base status in patients with pulmonary embolism

Aim To assess the prognostic value of lactate level for mortality in patients with pulmonary embolism (PE) and Pulmonary Embolism Severity Index (PESI) I-III and its independence of gas-analysis parameters and acid-base status. Methods This prospective observational study was conducted at the University Clinical Hospital Mostar from 2013 to 2017. On the first day after PE diagnosis, 1.5 mL of arterial blood was collected from 103 patients with PE. Partial pressure of oxygen in arterial blood, partial pressure of carbon dioxide in arterial blood, blood pH value, concentration of bicarbonates in arterial blood (HCO3-), base deficit, and oxygen saturation were analyzed. Lactate levels were assessed using blood samples taken from the cubital vein. Logistic regression analysis was used to assess the predictive value of gas-analysis variables, lactate level, PESI score, age, and sex for in-hospital death due to PE. Results The mortality in the group of PE patients was 19.1% (18 of 103 patients). Lactate level was an independent predictor of mortality (P = 0.002, odds ratio 0.06). HCO3- was also found to be a significant predictor (P = 0.022, odds ratio 2.4). Lactates were independent of other variables. Other gas-analysis parameters were not significant predictors of mortality. Conclusion In PE patients at low-intermediate risk of mortality (PESI I-III), lactate level was associated with a short-term mortality, independently of other gas-analytic parameters. Oxford Centre for Evidence-based Medicine level of evidence: 2.

Synchronous Adie's syndrome and type 1 antineuronal nuclear antibody (anti-Hu)-related paraneoplastic neurological syndromes as predictors of complete response in limited-stage small-cell lung cancer: A case report

Adies syndrome (AS) and paraneoplastic sensorimotor neuropathy with cerebellar ataxia (PSN CA) are extremely rare, rapidly progressive, autoimmune diseases associated with the development of antibodies against neuronal-specific Hu proteins that are abnormally expressed in small-cell lung cancer (SCLC). We herein present the unique case of a 55-year-old obese woman, previous heavy smoker, who, during treatment with standard cisplatin-etoposide chemotherapy for limited-stage SCLC, developed simultaneous AS and worsening symptoms consistent with PSN CA that led to significant neurological disability and severe axonal electrophysiological pattern on nerve conduction studies. Serology confirmed the presence of low-titre type 1 antineuronal nuclear antibodies (ANNA-1), previously referred to as anti-Hu antibodies. Following plasmapheresis, immunosuppressive therapy and physical rehabilitation, the neurological symptoms progressively improved. The tumour completely regressed, with no recurrence detected on subsequent radiological examinations. The aim of this case was to highlight the importance of a multidisciplinary team approach for early recognition and rapid treatment of paraneoplastic neurological syndromes (PNS) as key to achieving significant recovery and marked improvement of the neurological deficit. This report extends the literature by confirming earlier studies showing that the presence of serum ANNA-1 in SCLC, an aggressive type of pulmonary carcinoma that is challenging to treat, may portend a more favourable prognosis and response to chemotherapy. Thus, patients with SCLC and new-onset neurological symptoms should be tested for ANNA-1. The role of a multimodality approach to treating PNS is also emphasized.

Trends in incidence of lung cancer in Croatia from 2001 to 2013: gender and regional differences

Aim To provide an overview of the lung cancer incidence trends in the City of Zagreb (Zagreb), Split-Dalmatia County (SDC), and Croatia in the period from 2001 to 2013. Method Incidence data were obtained from the Croatian National Cancer Registry. For calculating incidence rates per 100 000 population, we used population estimates for the period 2001-2013 from the Croatian Bureau of Statistics. Age-standardized rates of lung cancer incidence were calculated by the direct standardization method using the European Standard Population. To describe incidence trends, we used joinpoint regression analysis. Results Joinpoint analysis showed a statistically significant decrease in lung cancer incidence in men in all regions, with an annual percentage change (APC) of -2.2% for Croatia, 1.9% for Zagreb, and -2.0% for SDC. In women, joinpoint analysis showed a statistically significant increase in the incidence for Croatia, with APC of 1.4%, a statistically significant increase of 1.0% for Zagreb, and no significant change in trend for SDC. In both genders, joinpoint analysis showed a significant decrease in age-standardized incidence rates of lung cancer, with APC of -1.3% for Croatia, -1.1% for Zagreb, and -1.6% for SDC. Conclusion There was an increase in female lung cancer incidence rate and a decrease in male lung cancer incidence rate in Croatia in 2001-20013 period, with similar patterns observed in all the investigated regions. These results highlight the importance of smoking prevention and cessation policies, especially among women and young people.

Regional pattern of trends in lung cancer incidence in Croatia, 2001-2013

Background: In Croatia in 2012 lung cancer was the most common solid tumor in men and the third most common tumor in women. Lung cancer incidence largely mirrors smoking prevalence, and more than one quarter of adult inhibitants of Croatia are everyday smokers. Aims: to provide an overview of the trends of lung cancer incidence in Zagreb, Split-Dalmatia County and Croatia. Methods: Incidence data were obtained from the National Cancer Registry. For calculating incidence rates and age standaridzed rates (ASR)we used population estimates from the Bureau of Statistics. ASR were calculated by the direct standardization method using the European Standard Population. For incidence trends we used joinpont regression analysis. Results: Lung cancer incidence rates in men show declining trend. Joinpoint analysis showed a significant decrease in the incidence for all regions, with estimated annual percentage change (EAPC) for Zagreb of -4.3%, for Croatia of -2.3%, and for SDC of -1.6%. In women there is an increasing trend. Joinpoint analysis showed a significant increase in the incidence for Croatia with EAPC of 1.6%. There was no significant increase for Zagreb and SDC. In terms of both sexes, joinpoint analysis showed a significant decrease in age - standardized incidence rates for Croatia with EAPC of -1%. There were no significant results for SDC and Zagreb. Conclusion: This study shows there is an increase in female lung cancer incidence rate and a decrease in male lung cancer incidence rate. Those findings correlate with decreasing trend of smoking prevalence among men and increasing trend among women and stress importance of smoking prevention and cessation policies especially among women and young people.

Predictor parameters for exercise intolerance in patients with chronic obstructive pulmonary disease (COPD)

Aim: The aim of this study was to investigate whether skeletal muscle and nutrition status parameters besides lung function parameters can predict exercise intolerance in COPD patients. Methods: The study recruited 140 patients with moderate (GOLD 2) and severe (GOLD 3) stable COPD. In all patients exercise tolerance was measured using a six-minute walk test (6-MWT). Lung function measurements (spirometry, lung diffusion), assessment of the level of dyspnea, fatigue, nutrition status and skeletal muscle function parameters were performed in all patients. Results: Age, peak expiratory flow (PEF), CO diffusion coefficient, general fatigue, waist circumference, suprailiac and abdominal skin folds, left inspiratory muscle strenght and thoracic vertebra index (OTT) were depicted as parameters which can explain 58,16% of the variability for the 6-MWT (m) results. The model for 6-MWT (%) explaining 48,60% variability of the test results depicted GOLD stage, body mass index, physical fatigue, waist circumference, suprailiac and abdominal skin folds, left inspiratory muscle strenght, OTT and lower limbs lenght as significant predictors. Discriminant analysis (excluding FVC and FEV 1 from the list of independent variables) depicted PEF, left inspiratory musle strenght, 6-MWT (%), fat free mass index, mental fatigue, difference in Borg dyspnea score and heart rate at the end of 6-MWT as significant predictor variables for the COPD severity stage with the 86,43% of diagnostic accuracy (GOLD 2 or GOLD 3). Conclusion: Our results suggest that skeletal muscle parameters and nutrition status parameters are independent predictor parameters for exercise intolerance and COPD severity stages.

P11. Efficacy and safety of erlotinib in advanced squamous cell lung cancer

Background Erlotinib is epidermal growth factor receptor (EGFR) tyrosine-kinase inhibitor which showed efficacy and tolerability in patients with advanced non-small cell lung cancer (NSCLC), especially in group of patients which harbor activating mutations in EGFR.