Leucocyte-counts and survival in lung cancer

Leukocytosis in non hematological malignancies--a possible tumor-associated marker

Leukocytosis (WBC counts 10,000/mm3) was detected in 77 out of 252 patients (30%) with ten different types of nonhematological malignancy (NHM) at the time of diagnosis. A full search including serological and bacteriological screening was performed to exclude other possible causes of leukocytosis. Among the different tumors, carcinomas of the lung and colorectum were the most prevalently associated with leukocytosis. Absolute monocytosis was found in 25% of the patients and absolute eosinophilia in only 4.8%. The leukocytosis was attributed mainly to an increase in the mature polymorphonuclears, suggesting a release mechanism of WBC from storage pools by factors secreted or induced by the tumor. Neither the age nor the sex of the patients affected the incidence or magnitude of leukocytosis. However, the presence of metastases was associated with a significantly higher incidence of leukocytosis (p less than 0.05). The associated leukocytosis may be regarded as a poor prognostic sign, and was associated with a significantly (p less than 0.007) shorter survival time. In contrast, absolute lymphocytosis may have a positive effect on the survival time (p = 0.01). Tumor-associated leukocytosis may be an additional tumor-associated marker, of value in assessing and monitoring patients with NHMs.

Prognostic factors in advanced colorectal carcinoma. Importance of lactic dehydrogenase level, performance status, and white blood cell count

In 220 patients with advanced colorectal carcinoma, objective tumor response to chemotherapy and survival were related to the following parameters: age, sex, performance status, time interval from diagnosis to metastases, initial site of metastases, and initial white blood cell count, lactic dehydrogenase, alkaline phosphatase, and carcinoembryonic antigen levels. Each variable was first evaluated separately. By conventional statistical methods, none of the variables significantly predicted response, although the following parameters significantly (p less than 0.01) predicted survival: Patients with an initially normal level of lactic dehydrogenase versus those with an abnormal level of lactic dehydrogenase had median survivals of 16 and 7.0 months, respectively; normal versus abnormal carcinoembryonic antigen levels, 23 and 9.2 months, respectively; white blood cell count of less than 10,000 versus greater than 10,000 cells/mm3, 11 and 7.0 months, respectively; performance status of greater than 70 versus less than 60, 11 and 6.6 months, respectively; and lung versus liver metastases, 12 and 8.0 months, respectively. By studying the variables together with multivariate analysis, we found that the most important variables in predicting response were the lactic dehydrogenase level and the white blood cell count. In predicting survival, the most important variables were the lactic dehydrogenase level, performance status, and lung involvement. We recommend that future randomized therapeutic trials for advanced colorectal carcinoma should delineate and perhaps stratify for the lactic dehydrogenase level, performance status, white blood cell count, and/or the presence of lung involvement.