Clinical Model to Predict Survival in Chemonaive Patients With Advanced Non-Small-Cell Lung Cancer Treated With Third-Generation Chemotherapy Regimens Based on Eastern Cooperative Oncology Group Data

Harvard University, Cambridge, Massachusetts, United States
Journal of Clinical Oncology (Impact Factor: 18.43). 02/2005; 23(1):175-83. DOI: 10.1200/JCO.2005.04.177
Source: PubMed


(1) Identify clinical factors that can be used to predict survival in chemotherapy-naive patients with advanced non-small-cell lung cancer (NSCLC) treated with third-generation chemotherapy regimens, and (2) build a clinical model to predict survival in this patient population.
Using data from two randomized, phase III Eastern Cooperative Oncology Group (ECOG) trials (E5592/E1594), we performed univariate and multivariate stepwise Cox regression analyses to identify survival prognostic factors. We used 75% of randomly sampled data to build a prediction model for survival, and the remaining 25% of data to validate the model.
From 1993 to 1999, 1,436 patients with stage IV or IIIB NSCLC with effusion were treated with platinum-based doublets (involving either paclitaxel, docetaxel, or gemcitabine). The response rate and median survival time were 20% and 8.2 months, respectively. One- and 2-year survivals were 33% and 11%, respectively. In multivariate analysis, six independent poor prognostic factors were identified: skin metastasis (hazard ratio [HR], 1.88), lower performance status (ECOG 1 or 2; HR, 1.46), loss of appetite (HR, 1.62), liver metastasis (HR, 1.32), >/= four metastatic sites (HR, 1.20), and no prior surgery (HR, 1.16). A nomogram using six pretreatment prognostic factors was built to predict 1- and 2-year survival.
Six pretreatment factors can be used to predict survival in chemotherapy-naive NSCLC patients treated with standard chemotherapy. Using our prognostic nomogram, 1- and 2-year survival probability of NSCLC patients can be estimated before treatment. This prognostic model may help clinicians and patients in clinical decision making, as well as investigators in research planning.

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    • "Unfortunately, of all patients with NSCLC 15% survive five years. Age, sex, histological type, stage, performance status, some genetic mutations and smoking are known as common prognostic factors (Hoang et al., 2005; Riquet et al., 2007; Albain et al., 2009; Caglar et al., 2009; Alimujiang et al., 2013; Kamsa-Ard et al., 2013; Pan et al., 2013). Some epidemiological studies evaluated whether epidemiologic properties had an effect on mortality or morbidity of cancer (Mutlu et al., 2011; 2013; Fuhrman et al., 2013; Holick et al., 2013). "
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    ABSTRACT: Background: Some epidemiological studies reported that sunlight exposure and highvitamin D levels may decrease the morbidity and mortality related to cancer. We aimed to evaluate whether sunlight exposure has an impact on survival in patients with non small cell lung cancer. Materials and methods: A total of 546 patients with NSCLC from two different regions (Kayseri and Adana) differing according to sunlight exposure were analysed retrospectively. Results: The median overall survival (OS) rates were 11. 6 (CI: 9.50-13.6) and 15.6 months (CI: 12.4-18.8) for Kayseri and Adana, respectively, in all patients (p=0.880). Conclusions: There were no differences between groups in terms of OS. While there is strong evidence regarding inverse relationship between cancer incidence and sunlight exposure, it is still controversial whether sunlight exposure is a good prognostic factor for survival in patients with lung cancer.
    Full-text · Article · Nov 2013 · Asian Pacific journal of cancer prevention: APJCP
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    • "The traditional evaluation of prognosis in non-small cell lung carcinoma (NSCLC) has relied, as in most other malignant tumors, on the stage of disease at the time of clinical presentation. Other factors currently commonly considered include performance status, weight loss, and presence or absence of symptoms at diagnosis, as well as time-honored pathologic parameters, eg, tumor size, tumor differentiation, and histologic subtype.3 However, advances in molecular biology have provided important insights into other potentially significant prognostic biomarkers during the last decade.4 "
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    ABSTRACT: Phosphorylation of the H2AX histone is an early indicator of DNA double-strand breaks and of the resulting DNA damage response. In the present study, we assessed the expression and prognostic significance of γ-H2AX in a cohort of 96 patients with operable non-small cell lung carcinoma. Ninety-six paraffin-embedded specimens of non-small cell lung cancer patients were examined. All patients underwent radical thoracic surgery of primary tumor (lobectomy or pneumonectomy) and regional lymph node dissection. γ-H2AX expression was assessed by standard immunohistochemistry. Follow-up was available for all patients; mean duration of follow-up was 27.50 ± 14.07 months (range 0.2-57 months, median 24 months). Sixty-three patients (65.2%) died during the follow-up period. The mean survival time was 32.2 ± 1.9 months (95% confidence interval [CI]: 28.5-35.8 months; median 30.0 months); 1-, 2- and 3-year survival rates were 86.5% ± 3.5%, 57.3% ± 5.1%, and 37.1% ± 5.4%, respectively. Low γ-H2AX expression was associated with a significantly better survival as compared with those having high γ-H2AX expression (35.3 months for low γ-H2AX expression versus 23.2 months for high γ-H2AX expression, P = 0.009; hazard ratio [HR] 1.95, 95% CI: 1.15-3.30). Further investigation with multivariate Cox proportional hazards regression analysis revealed that high expression of γ-H2AX remained an independent prognostic factor of shorter overall survival (HR 2.15, 95% CI: 1.22-3.79, P = 0.026). A combined p53/γ-H2AX analysis was performed, and we found that the p53 low/γ-H2AX low phenotype was associated with significantly better survival compared with all other phenotypes. Our study is the first to demonstrate that expression of γ-H2AX detected by immunohistochemistry may represent an independent prognostic indicator of overall survival in patients with non-small cell lung cancer. Further studies are needed to confirm our results.
    Full-text · Article · Oct 2012 · OncoTargets and Therapy
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    • "Metastatic non-small-cell lung cancer (NSCLC) is currently considered an incurable disease; median overall survival is 12 months with platinum-based chemotherapy [1,2] and only 3.5% of patients survive five years after diagnosis [3]. Therapies targeting EGFR mutations have revolutionized the treatment of NSCLC; however, additional targeted therapies are lacking. "
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    Full-text · Article · Sep 2011 · Journal of Translational Medicine
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