SMALL-CELL LUNG-CANCER - ANALYSIS OF FACTORS INFLUENCING THE RESPONSETO TREATMENT AND SURVIVAL

The aims of this study were to identify prognostic factors in patients (pts) with small cell lung cancer and to identify dominant prognostic factors independent of disease stage, to define prognostic subsets th rough recursive partitioning and amalgamation (RPA) and to analyze the clinical characteristics of long-term survivors. The prognostic signi ficance of 27 pre-treatment variables was evaluated in 144 pts seen at a single institution. The current study confirmed the superior outcom e for pts with limited disease (LD) in terms of response, response dur ation, time to treatment failure and survival when compared to those w ith extensive disease (ED). None of the variables independently predic ted for response in patients with LD. Response correlated significantl y with a good performance status (PS) for pts with ED and for the whol e group. A good PS was the most significant predictor for prolonged su rvival in pts with LD. In ED a longer survival was associated with a n ormal pre-treatment albumin value, absence of weight loss and female g ender. When the whole group was considered, PS and number of metastati c sites were identified as the most influential factors for survival i ndependent of disease stage. RPA analysis defined 3 prognostic subsets based on stage of disease, PS and number of metastatic sites. The bes t survival rates were seen in pts with LD with a good PS and pts with ED, only one metastatic site and a good PS. 11% of pts survived > 2 ye ars (18% LD, 6% ED). A complete response to chemotherapy was the most important predictor for long-term survival. Comparison of the data fro m this study with published results of protocol studies showed similar outcomes.