Henry Stevenson, MD; Adi F. Gazdar, MD; Ruby Phelps, AAS; R. Ilona Linnoila, MD; Daniel C. Ihde, MD; Bimal Ghosh, MD; Thomas Walsh, MD; Edward L. Woods, MD; Herbert Oie, PhD; Teresa O'Connor, MPH; Robert Makuch, PhD; Barnett S. Kramer, MD; James L. Mulshine, MD
Objective: To determine the relation between in-vitro establishment of tumor cell lines and survival in patients with non-small-cell lung cancer.
Design: Cohort study.
Setting: Single-institution tertiary care center.
Patients: One hundred twenty-three consecutive patients with non-small-cell lung cancer from whom a viable tumor specimen could be obtained.
Intervention: Tumor tissue was removed at the time of entry into a therapeutic protocol. The tumor tissue was processed in the laboratory for attempted cell-line establishment. Patients classified as potentially curable (stages I, II, and IIIA) were treated with surgical resection, radiation therapy, or a combination. Patients suitable for palliative therapy only (stages HIB and IV) were treated with radiation therapy with or without chemotherapy. Chemotherapy was based on in-vitro drug sensitivity when available. Cell-line establishment was correlated to clinical outcome.
Measurements and Main Results: Univariate analysis of survival was done using the log-rank test; multivariate analysis was done by Cox modeling step-up and step-down techniques. Cell lines were established from the tumor specimens of 25 patients (20%). Those patients experienced a median survival of 7 months compared with 18 months in patients from whom cell lines could not be established (P < 0.001). In the 61 patients with potentially curable disease, 8 patients (13%) with cell lines established had a median survival of 8 months compared with 32 months for those without cell lines established (P = 0.001). In the 62 palliative group patients, the median survival of the 17 patients (27%) from whom tumor cell lines were established was 5 months compared with 7 months for those without cell lines (P = 0.15). Multivariate analysis in both groups showed cell-line establishment to be a significant indicator of prognosis (P < 0.0001 for curable group; P < 0.01 for palliative group).
Conclusion: In-vitro tumor growth is related to decreased patient survival, which in turn reflects the biologic aggressiveness of cancers giving rise to these tumor cell lines.
Stevenson H, Gazdar AF, Phelps R, et al. Tumor Cell Lines Established in Vitro: An Independent Prognostic Factor for Survival in Non-Small-Cell Lung Cancer. Ann Intern Med. 1990;113:764–770. doi: 10.7326/0003-4819-113-10-764
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Published: Ann Intern Med. 1990;113(10):764-770.
Hematology/Oncology, Lung Cancer, Pulmonary/Critical Care.
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