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Age and Comorbidity As Independent Prognostic Factors in the Treatment of Non–Small-Cell Lung Cancer: A Review of National Cancer Institute of Canada Clinical Trials Group Trials

Timothy R. Asmis, Keyue Ding, Lesley Seymour, Frances A. Shepherd, Natasha B. Leighl, Tim L. Winton, Marlo Whitehead, Johanna N. Spaans, Barbara C. Graham, Glenwood D. Goss

From the National Cancer Institute of Canada Clinical Trials Group, Kingston, Ontario, Canada

Corresponding author: Glenwood Goss, MD, Medical Oncology, The Ottawa Hospital Regional Cancer Centre, The University of Ottawa, 503 Smyth Rd, Ottawa, Ontario, Canada, K1H 1C4; e-mail: ggoss{at}ottawahospital.on.ca

Purpose: This study analyzed patients enrolled in two large, prospectively randomized trials of systemic chemotherapy (adjuvant/palliative setting) for non–small-cell lung Cancer (NSCLC). The main objective was to determine if age and/or the burden of chronic medical conditions (comorbidity) are independent predictors of survival, treatment delivery, and toxicity.

Patients and Methods: Baseline comorbid conditions were scored using the Charlson comorbidity index (CCI), a validated measure of patient comorbidity that is weighted according to the influence of comorbidity on overall mortality. The CCI score (CCIS) was correlated with demographic data,(ie, age, sex, race), performance status (PS), histology, cancer stage, patient weight, hemoglobin, alkaline phosphatase, lactate dehydrogenase, outcomes of chemotherapy delivery (ie, type, total dose, and dose intensity), survival, and response.

Results: A total of 1,255 patients were included in this analysis. The median age was 61 years (range, 34 to 89 years); 34% of patients were elderly (at least 65 years of age); and 31% had comorbid conditions at randomization. Twenty-five percent of patients had a CCIS of 1, whereas 6% had a CCIS of 2 or greater. Elderly patients were more likely to have a CCIS equal to or greater than 1 compared with younger patients (42% v 26%; P < .0001), as were male patients (35% v 21%; P < .0001) and patients with squamous histology (36% v 29%; P = .001). Although age did not influence overall survival, the CCIS appeared prognostic (CCIS 1 v 0; hazard ratio 1.28; 95%CI, 1.09 to 1.5; P = .003).

Conclusion: In these large, randomized trials, the presence of comorbid conditions (CCIS 1), rather than age more than 65 years, was associated with poorer survival.

Supported by the Canadian Cancer Society Grant No. 4493, and supported in part by Grant Nos. CA161003 from Bristol Myers Squibb (BR18), CA04326 from the National Cancer Institute (JBR10), 12150 from the National Cancer Institute of Canada, and CA31946 from the Cancer and Leukemia Group B.

Presented at the 42nd Annual Meeting of the American Society of Clinical Oncology, June 2-6, 2006, Atlanta, GA.

Authors’ disclosures of potential conflicts of interest and author contributions are found at the end of this article.

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