SURVIVAL PREDICTORS IN ADVANCED NON-SMALL-CELL LUNG-CANCER

The authors studied the influence on survival of 21 clinical, anatomic al, haematological and biochemical factors evaluated, at diagnosis, of 411 patients (pts) with advanced Non Small Cell Lung Cancer (NSCLC) f ollowed in our department between 1984 and 1990. Most of the patients were male (347 - 84.4%) and only 64 (15.6%) were females. Median age w as 62 years, but was slightly higher in females. Only 34 patients were aged under 45 years. Squamous cell carcinoma (215 pts - 52%) and aden ocarcinoma (152 pts - 37%) were the most frequent histologic types. Pe rformance status was poor - only 103 (25%) continued active; 120 (29%) spent at least half of the time in bed; 188 (46%) were severely limit ed. After staging, 179 (44%) presented locally advanced disease (stage IIIB) and 232 (56%) metastatic dissemination (stage IV). Therapy was defined by the oncologic group according to individual characteristics and based on clinical grounds. Anti-neoplasic therapy was performed i n 225 (55%), chemotherapy alone in 121 (30%), radiation therapy alone in 67 (16%), and sequential combined treatment (chemotherapy and thora cic radiation) in 37 (9%). Until 1987, the main chemotherapy regimen w as MACC (Metrotrexate + Adriamycine + Cyclophosphamide + Lomustin), af terwards VP(M) (Cisplatin + Vimblastin + Mitomycine). Radiation therap y was performed using Co-60, 2 Gy/day, 5 days a week, for 4 weeks (app roximately 45 Gy total). The response rate was poor - four complete re sponses (2%), 42 (19%) partial responses. The overall median survival was 4.3 months and only 5% of patients were alive after 18 months of f ollow up. Prognostic importance of each characteristic studied was ini tially done by unifactorial analysis, followed by multifactorial analy sis according to two methods: Cox proportional hazards model and recur sive partitioning amalgamation - RECPAM. Regardless of the method used , the main determinants of survival were found to be performance statu s (Zubrod), weight loss and serum albumin. Other factors such as the s taging (presence or absence of metastasis), lymphocytes, lactic dehydr ogenase, and hoarseness were also significant. It is noteworthy that a ge and histological type were irrelevant; sex and hoarseness only prov ed important when integrated within a multifactorial model. The overal l prognostic evaluation and therapeutic decision of advanced NSCLC pat ients could be improved by combining the prognostic value of TNM with that of performance status, weight loss and serum albumin. These progn ostic guidelines must be taken into account when designing new clinica l trials.