CHEMOTHERAPY IN SMALL-CELL LUNG-CARCINOMA - PROGNOSTIC VALUE OF COMPLETE RESPONSE IN 1280 PATIENTS

Objective: Pretherapeutic prognostic factors for patients given chemot herapy for small cell lung carcinoma have been widely studied. We eval uated response to chemotherapy in patients included in 4 multicentric trials with less restrictive entry criteria in order to determine the contribution of clinical outcome as a predictive factor. Methods: Pret herapeutic and therapeutic pronostic factors were assessed in 1280 pat ients included in 4 successive multicentric therapeutic trials on chem otherapy for small cell lung carcinoma conducted from January 1, 1983 to April 1, 1992. Logrank test for univariate analysis and Cox's stepw ise method for multivariate analysis were used to evaluate the results . Results: Univariate analysis identified prethelapeutic factors as si gnificant for prognosis: Karnofsky index (p < 0.0001), alkaline phosph atase level (p < 0.0002), white cell count (p < 0.0005), age (p = 0.00 07), presence of brain metastasis (p = 0.0004), presence of liver meta stasis (p = 0.03), initial extension (p = 0.04). Multivariate analysis taking into account pretherapeutic and therapeutic factors demonstrat ed that complete response after the second and after the sixth treatme nt session were predictive of longer survival (p < 0.0001). This facto r was more powerful than all the pretherapeutic factors including the Karnofsky index, initial extension and brain metastasis. Conclusion: F or patients with small cell lung carcinoma, the pronostic value of ear ly response to chemotherapy suggests that high-doses should be used st arting at the first session.