Effect of statins on C-reactive protein in patients with coronary artery disease

Abstract

patients who had SCLC-LEMS with a matched group of patients who had SCLC only. Survival data were available for 15 SCLC-LEMS patients seen in a neuromuscular clinic since 1987. All had biopsyproven SCLC, typical clinical and electromyographic features of LEMS, and raised titres of anti-P/Q-type voltagegated calcium channel antibodies detectable by RIA. Hospital records were available for SCLC patients who had no neurological illness and who had participated in randomised SCLC treatment trials between 1988 and 1997 at the Middlesex and University College Hospitals, London, UK. We matched each of the 15 SCLC-LEMS patients with five or six SCLC-only patients (n=81) for sex, age at SCLC diagnosis, tumour extent (limited or extensive), and treatment (chemotherapy of radiotherapy). Computer matching was done by medical staff masked to the SCLCLEMS patients’ survival data. Three SCLC-LEMS patients had extensive disease at tumour diagnosis; four did not receive specific tumour treatment because they died soon after diagnosis. With one exception, symptoms of LEMS predated the diagnosis of SCLC (range 0·3–4·7 years). At the time of the study, four SCLC-LEMS patients were alive with no evidence of tumour recurrence after a median of 6 years (range 1·5–8·5) since tumour detection and treatment. Kaplan-Meier survival estimates (figure) show a significantly shorter median survival time from the diagnosis of SCLC in SCLC-only patients (10 months) than in the SCLC-LEMS patients (17·3 months, p=0·048, Log-rank test). Factors contributing to this better survival rate in SCLC-LEMS might be a slower rate of growth in tumours that provoke LEMS, or lead-time bias, in that once LEMS is diagnosed, the vigilance for associated lung cancer may be increased. In SCLC-LEMS, however, tumour macrophage infiltration is greater and MHC class I antigen expression less in patients with SCLC only, which implies more tumour-cell destruction in LEMS. Moreover, the time between onset of LEMS and clinical presentation of the tumour can be longer than would be predicted from the estimated ratio of tumour growth on the basis of radiographic analysis of non-LEMS patients. These observations and our survival data support the view that the autoimmune response in LEMS retards tumour growth. Therefore, the recognition of LEMS in any patients with SCLC could have important implications for long-term outcome after antitumour therapy.