PRETREATMENT PROGNOSTIC FACTORS FOR SURVIVAL IN SMALL-CELL LUNG-CANCER - A NEW PROGNOSTIC INDEX AND VALIDATION OF 3 KNOWN PROGNOSTIC INDEXES ON 341 PATIENTS

Aims: a) To identify which pretreatment clinical or blood parameters w ere predictive of patient survival in small-cell lung cancer (SCLC) in a retrospective analysis. b) To validate three known prognostic indic es: Royal Marsden Model (index 1), London Group (index 2) and Manchest er Score (index 3). Patients and methods. From 1951 to 1993, 341 SCLC patients were treated with chemotherapy with or without surgery or rad iotherapy. Univariate and multiple regression analyses of survival wer e performed and the feasibility of these models was explored, index 1: Karnofsky index, albumin: sodium and alkaline phosphatase; index 2: E COG performance status (PS), albumin and alanine transaminase; and ind ex 3: lactate dehydrogenase (LDH), disease extent, sodium, Karnofsky i ndex, alkaline phosphatase and bicarbonate. Results. Significant progn ostic factors for survival after univariate and multiple regression an alysis were: disease extent, PS, creatine kinase, neutrophilia, LDH, h ypoalbumine-mia, hyperglycemia and bicarbonate. 4 new prognostic index was performed that included LDH, hypoalbuminemia, neutrophilia, disea se extent and PS. It defined three prognostic groups (PG). Median surv ival and two-year survival for these PG were 12.3, 8 and 3.4 months an d 16.5%, 2.3% and 0%, respectively. The following PG were identified a fter application of the three models proposed: Index 1 identified two PG with 0% and 16.6% two-year survival (P < 0.001); index 2 detected t hree PG with 0%, 5% and 15.7% two-year survival (P < 0.001) and index 3 detected three PG with 0%, 2.5% and 16.2% two-year survivals, respec tively (P < 0.001). Conclusion: A new prognostic index is proposed all owing identification of three different PG. The feasibility of three k nown prognostic models was validated and demonstrated, Variables other than disease extent or PS (albumin or LDH) should be taken into accou nt in designing future clinical trials.