PREDICTIVE FACTORS OF TUMOR RESPONSE AND PROGNOSTIC FACTORS OF SURVIVAL DURING LUNG-CANCER CHEMOTHERAPY

The aim of this study was (i) to determine predictive factors of a com plete response to chemotherapy in small cell lung cancer (SCLC) and pr edictive factors of an objective response in non-small cell lung cance r (NSCLC) and (ii) to determine whether prognostic factors are differe nt with regard to treatment response and survival. Ninety-nine patient s with SCLC and two hundred and two patients with NSCLC received chemo therapy. The following variables were recorded prior to treatment: tum or, node, metastasis status, performance status, body weight loss, blo od leukocyte count, serum sodium, serum albumin, lactate dehydrogenase (LDH), alkaline phosphatase, serum NSE, serum TPS, and serum CYFRA 21 -1. Tumor response was analyzed at the 10th week. Analysis of survival were done using the landmark method. Hazard ratios of the significant prognostic variables of survival were calculated using the Cox's mode l. Odds ratios of the significant predicting factors of response were calculated by stepwise logistic regression. In SCLC, the significant d eterminants of poor survival were: lack of complete response (HR: 2.04 ), weight loss (HR: 1.76), high serum LDH level (HR: 1.64), and high s erum TPS level (HR: 2.47). A high serum TPS level was the only factor among those studied able to predict lack of achievement of complete re sponse (OR: 0.39). In NSCLC, significant determinants of poor survival were: no objective response (HR: 2.28), poor performance status (HR: 2.52), presence of metastases (HR: 1.51), and high serum CYFRA 21-1 le vel (HR: 1.84). On the other hand, a high serum TPS level (OR: 0.50), the presence of metastases (OR: 0.45), and a leukocyte blood count ove r 10,000/mu l (OR: 0.43) were independent determinants for a patient n ot to achieve an objective response. We concluded that the predictive factors of complete response in SCLC remain to be defined. On the othe r hand, in NSCLC three variables contribute to the prediction of an ob jective response. Finally, determinants of survival differ from predic tive factors of response.