Journal of Clinical Oncology, Vol 9, 1618-1626, Copyright © 1991 by American Society of Clinical Oncology
Survival determinants in extensive-stage non-small-cell lung cancer: the Southwest Oncology Group experience
KS Albain, JJ Crowley, M LeBlanc and RB Livingston
Loyola University Medical Center, Maywood, IL.
We analyzed the 2,531-patient Southwest Oncology Group extensive-stage
non-small-cell lung cancer (ENSCLC) data base from 1974 to 1988 to (1)
assess the interactions of host- or tumor-related prognostic factors and
therapy using Cox modeling and recursive partitioning and amalgamation
(RPA) to determine whether each independently predicts outcome, and (2) use
RPA to define prognostic subsets with different survival potentials. Good
performance status (PS), female sex, and age greater than or equal to 70
years were significant independent predictors in a Cox model applied to the
entire population. In a second Cox model for patients with good PS enrolled
on recent studies, hemoglobin level greater than or equal to 11.0 g/dL,
normal lactate dehydrogenase (LDH), normal calcium, and a single metastatic
site were significant favorable factors. The use of cisplatin was an
additional independent predictor of improved outcome in both Cox models
after adjustments for year of accrual and all prognostic variables. The
favorable effect of cisplatin was observed in each of six RPA-derived
subgroups from the entire population. A second RPA of 904 patients from
recent trials (nearly all received cisplatin-based therapy) resulted in
three distinct prognostic subsets based on PS, age, hemoglobin, and LDH;
greater than or equal to 1-year survivals were 27%, 16%, and 6% (P less
than .0001). The best survival occurred for patients with a good PS who had
a hemoglobin level greater than or equal to 11 g/dL and who were older than
47 years. This analysis suggests that although several factors were
independent variables in the Cox models, three important prognostic
subgroups were easily defined through RPA. Together with other analyses,
our results suggest the need to modify the stage IV category in NSCLC.
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