A PRACTICAL PROGNOSTIC INDEX FOR INOPERABLE NON-SMALL-CELL LUNG-CANCER

Radical radiotherapy is widely used to treat inoperable non-small-cell lung cancer (NSCLC) although only a small number of patients benefit in the long run from this intensive treatment. There is a small propor tion of lon,a-ter-m survivors who might derive advantage from even mor e aggressive radiotherapy combined with chemotherapy. In order to supp ort optimal treatment selection we have carried our univariate and mul tivariate analyses of possible prognostic variables in the retrospecti ve data of 502 NSCLC patients treated at one institute with external r adiotherapy, both with curative and palliative intent. To obtain more accurate tools for a rational treatment decision, we identified, by us ing Cox's proportional-hazards model, the five most powerful determina nts of overall survival and combined them to a prognostic index. On th e basis of only the number of these risk factors (advanced stage, gene ral or metastatic symptoms, poor performance status, anemia and tumor size of at least 7 cm), the patient falls into one of the six possible prognostic groups and these groups turned out to be identifiable as s eparate prognostic clusters. Thirty-one per cent of the patients have three or more risk factors and a median survival of 5-7 months compare d with Is months for patients without any non-favorable factor. Furthe rmore, the prognostic factors were so strong that multivariate analyse s did not reveal the treatment selection to have any significant influ ence on survival. As each of the five variables have the advantage of being routinely available, our index is simple enough to be used in da ily clinical practice. The clinical value of the prognostic index shou ld be verified by using independent data.