PROGNOSTIC FACTORS AND PROGNOSTIC STAGING SYSTEM FOR SMALL-CELL LUNG-CANCER

This study was performed to assess the prognostic factors and the pred ictors of long-term (3-year) survival in patients with small cell carc inoma of the lung, accrued in one randomized trial, and to define pati ent subgroups showing significantly different survivals using recursiv e partitioning and amalgamation analysis, A total of 300 patients with small cell carcinoma of the lung were entered into a randomized study comparing cyclophosphamide, adriamycin and vincristine (CAV), cisplat in and etoposide (PE) and alternating treatments of CAV and PE. Of the se, 286 patients were analysed for the present study of prognostic fac tors, Multivariate analysis showed that poor performance status (2-3) (P = 0.0001), extensive disease (P = 0.0015) and abnormally elevated s erum lactate dehydrogenase (P = 0.0001) and alkaline phosphatase (P = 0.0013) were independently adverse pretreatment prognostic factors. Of limited disease patients, performance status (P = 0.029) and white bl ood cell count (P = 0.044) had a significant influence on the probabil ity of 3-year disease-free survival, Using recursive partitioning and amalgamation analysis, three classes of similar prognosis were identif ied: the most favorable class was defined by knowledge of lactate dehy drogenase (normal), performance status (0-1) and serum sodium levels ( normal) with median survival time of 16.0 months, and the class with t he poorest prognosis was defined by knowledge of lactate dehydrogenase (elevated) and performance status (2-3) (median survival time 6.6 mon ths), The intermediate class had a median survival time of 9.4 months, In conclusion, this subclassification system will be used for the des ign, implementation and interpretation of clinical studies as well as decision-making in individual patients.