THE NATURAL COURSE IN NONRESECTABLE NON-SMALL-CELL LUNG-CANCER - A CRITICAL ANALYSIS

Background: In patients with nonresectable non-small cell lung cancer (NSCLC) only receiving best supportive care, the individual survival t ime varies as widely as in those patients actively treated with chemo- and radiotherapy. Therefore, factors which might influence the natura l course in untreated patients were investigated and the outcome was c ompared with the results of chemo- and radiotherapy. Patients and Meth ods: From the past history of 274 patients with nonresectable NSCLC su bjects were selected retrospectively on the criteria which correspond to those for patients to be enrolled in a therapeutic study. These pat ients, however, should have had no treatment besides best supportive c are. 169 patients were eligible and, furthermore, arbitrarily grouped in 'early death', i. e., into those 97 patients who died within 8 mont hs, and 'late death', i. e., the 72 ones dying later. 'Early death' pa tients were characterized by more frequent adeno carcinomas, higher ga mma GT and alkaline phosphatase levels, but the groups did not differ in age, sex. performance status, tumor stage, grading, and duration of symptoms at the time of diagnosis. Risk factors for 'early death' (Od ds ratio) were high values of white blood cell count and CEA, low forc ed expiratory volume (FEV1) and a visible tumor in bronchoscopy. Resul ts: Median survival time of all 274 patients was 5.0 months, in the se lected 169 patients 70, in 'early death' 4.1, and in 'late death' 15.5 months. Compared to patients treated with chemo- or radiotherapy, the median survival time of the 'late death' corresponds to those of favo rable reports of chemo- or radiotherapeutic studies with an assumed 'r esponse rate' of 43% (72 of 169 patients). Conclusions: The natural co urse in non-small cell lung cancer, depending on tumorspecific propert ies, is of the same influence as therapeutic means, with respect to me dian surval time.