Six cases of primary lung cancer producing granulocyte colony-stimulating factor; clinical and pathological analysis

Abstract

Six cases of granulocyte colony-stimulating factor (G-CSF)-producing primary lung cancer were reviewed clinicopathologically. All presented cases were male, who ranged in age from 48 to 71 years old (mean age: 56.0 years old) and were referred to our hospital complaining of fever. Their laboratory data on admission showed marked leukocytosis (14000˜39000/μl), thrombocytosis (37.1˜64.0×10⁴/μl), elevation of CRP (6.9˜21.2mg/dl), and a high serum G-CSF concentration (78.0˜2150.0pg/ml). All cases underwent almost complete resection. Histopathologically, resected tumors were diagnosed as pleomorphic carcinoma, large cell carcinoma and poorly differentiated squamous cell carcinoma in each 2 cases respectively. Immunohistochemical staining with anti-G-CSF monoclonal antibody showed positive results in the tumors of all cases. We diagnosed all cases as G-CSF-producing lung cancer. One case was in stage IB, three were in stage IIB, and two were in stage IIIA. We could perform postoperative adjuvant chemotherapy in only three patients because of the rapid progression of G-CSF-producing lung cancer. So, 3-year survival was achieved in only two patients with stage IB and stage IIB. One of them has survived without recurrence for 36 months, but the other case had pulmonary and bone metastasis and died as a result of the tumors 36 months after surgery. The other four patients died due to recurrence within 10 months post-operatively. As G-CSF-producing lung cancer has a poor prognosis despite complete resection, it is important that a more effective adjuvant therapy be established.