Exactly How Does Lung Cancer Kill Patients?
Larry Nichols, Rachel Saunders, Friedrich Knollmann. University of Pittsburgh Medical Center, PA
Background: Little is published identifying or quantifying the causes of death of lung cancer patients. Autopsies of lung cancer patients are ideally suited to shed light on the mechanisms of death of these patients.
Design: 100 autopsies of patients who died of lung cancer from 1990 through 2009 were analyzed to tabulate and analyze the causes of death.
Results: 62 of the patients were male and 38 female. 82 were white, 17 black and 1 east Asian. The average age was 66 (range 33-88). 47 of the cancers were adenocarcinomas, 26 squamous cell carcinomas, 18 small cell carcinomas, 8 large cell undifferentiated carcinomas and 1 mucoepidermoid carcinoma. Tumor burden was judged to be the immediate cause of death in 34 cases, including 24 cases of extensive metastases, 7 cases of lung tumor burden causing respiratory failure and 3 cases of local invasion (1 invading heart, 1 invading nervous system, 1 invading pulmonary artery and vena cava). Infection was the immediate cause of death of 21 patients, including 16 pneumonias. Complications of metastatic or extrapulmonary invasive disease were the immediate cause of death in 18 cases, including 9 involving the heart, 4 liver and 3 brain. Other immediate causes of death were pulmonary hemorrhage (12 cases), pulmonary embolism (9 cases, 2 tumor emboli) and pulmonary diffuse alveolar damage (6 cases). From a functional (pathophysiologic) perspective, respiratory failure, usually due to a combination of causes including emphysema, obstructive lung disease, pneumonia, hemorrhage, embolism, pneumonectomy, lobectomy and lung injury in addition to tumor could be regarded as the immediate cause of death in 37 cases. Almost all 100 patients had contributing causes of death and lung cancer was the underlying cause of their deaths. Patients who died with, but not of lung cancer (with lung cancer only a contributing cause of death), not included in the main analysis of this study, almost all died of atherosclerotic cardiovascular disease or smoking-related disease. 40 patients received no treatment, 14 because the lung cancer was not diagnosed antemortem. Rare mechanisms of death included paraneoplastic Lambert-Eaton syndrome, thrombosis of pulmonary artery and vena cava stents and platypnea-orthodeoxia syndrome due to tumor emboli with a patent foramen ovale.
Conclusions: The multiplicity and complexity of the causes of death of lung cancer patients pose challenges for efforts to extend and enhance the quality of their lives, but knowing the specific causes is important for these efforts.
Monday, February 28, 2011 2:15 PM
Platform Session: Section G, Monday Afternoon