title: Prognostic impact of paraneoplastic cushing's syndrome in small-cell lung cancer.
abstract: BACKGROUND
  Paraneoplastic Cushing's syndrome (CushingPS) in small-cell lung cancer is rare but severe.
  
  
  METHODS
  We studied 383 patients with small-cell lung cancer diagnosed between 1998 and 2012. Among them, 23 patients had CushingPS, 56 had other paraneoplastic syndrome (OtherPS), and 304 had no paraneoplastic syndrome (NoPS).
  
  
  RESULTS
  After comparison of the three groups, we observed that CushingPS patients had more extensive disease: 82.6% versus 67.8% versus 53.3% (p = 0.005), respectively, with more than two metastatic sites: 63.2% versus 15.8% and 24.1% (p ≤ 0.001), a higher World Health Organization performance status (2-4): 73.9% versus 57.1% versus 43.7% (p = 0.006), greater weight loss (≥10%): 47.8% versus 33.9% versus 16.4% (p ≤ 0.001), reduced objective response to first-line treatment: 47.6% versus 74.1% versus 71.1% (p = 0.04), and poorer sensitivity to first-line treatment: 19% versus 38.9% versus 48.6% (p = 0.01). NoPS patients, with World Health Organization performance status of 3-4, had extensive disease at diagnosis, with response, sensitivity to first-line treatment, and survival similar to the CushingPS group. At relapse, the CushingPS group had no objective response to second-line treatment versus 25% versus 42.8% in OtherPS and NoPS groups, respectively (p = 0.005). The median survival of CushingPS patients was 6.6 months versus 9.2 months for OtherPS and 13.1 months for NoPS patients (p ≤ 0.001). CushingPS is a prognostic factor of death (hazard ratio, 2.31; p ≤ 0.001).
  
  
  CONCLUSIONS
  CushingPS is the worst form of the paraneoplastic syndromes with particularly extensive tumors. Reduced objective response and sensitivity to first-line treatment and no response to second-line treatment suggest starting palliative care early at first line and exclusively at relapse.
authors.affiliation: *Oncology Coordination Centre, Grenoble University Hospital, Grenoble, France; §Medical Oncology Clinic, Grenoble University Hospital, Grenoble, France; †INSERM Unit 823, Institut Albert Bonniot, Grenoble, France; ‡Pneumology Clinic, Multidisciplinary Thoracic Oncology Group, Grenoble University Hospital, Grenoble, France; ‖Endocrinology and Nutrition, Grenoble University Hospital, Grenoble, France; and ¶Medical Intensive Care Unit, Grenoble University Hospital, Grenoble, France.
authors.forename: Hélène
authors.initials: H
authors.lastname: Nagy-Mignotte
authors.forename: Oxana
authors.initials: O
authors.lastname: Shestaeva
authors.forename: Lucile
authors.initials: L
authors.lastname: Vignoud
authors.forename: Pascale
authors.initials: P
authors.lastname: Guillem
authors.forename: Stéphane
authors.initials: S
authors.lastname: Ruckly
authors.forename: Olivier
authors.initials: O
authors.lastname: Chabre
authors.forename: Linda
authors.initials: L
authors.lastname: Sakhri
authors.forename: Michael
authors.initials: M
authors.lastname: Duruisseaux
authors.forename: Mireille
authors.initials: M
authors.lastname: Mousseau
authors.forename: Jean-François
authors.initials: JF
authors.lastname: Timsit
authors.forename: Denis
authors.initials: D
authors.lastname: Moro-Sibilot
mesh_terms: D000368:Aged; D003480:Cushing Syndrome / Q000209:etiology* / Q000401:mortality / Q000473:pathology; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008175:Lung Neoplasms / Q000150:complications* / Q000401:mortality / Q000473:pathology; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D010257:Paraneoplastic Syndromes / Q000209:etiology* / Q000401:mortality / Q000473:pathology; D011379:Prognosis; D055752:Small Cell Lung Carcinoma / Q000150:complications* / Q000401:mortality / Q000473:pathology; D015996:Survival Rate