Paralkar Vikram R, Li Tianyu, Langer Corey J
Department of Internal Medicine, Temple University Hospital, Philadelphia, PA.
Clin Lung Cancer. 2008 Mar;9(2):116-21. doi: 10.3816/CLC.2008.n.018.
With the increasing use of magnetic resonance imaging and positron emission tomography for staging non-small-cell lung cancer (NSCLC), the demographics, performance status (PS), and distribution of metastases at diagnosis in this patient population are changing. We therefore reassessed the prognostic implications of baseline clinical variables in the modern era.
We retrospectively evaluated the charts of 172 consecutive, unselected patients aged 41-89 years (median, 62 years) with stage IV NSCLC monitored at the Fox Chase Cancer Center, a tertiary referral center, between October 2000 and August 2003. Cox proportional models were used to conduct univariate and multivariate analyses of baseline prognostic factors.
Median age was 62 years; 79% of patients were PS 0/1 at first presentation. Fifty-six percent had single organ metastasis; 35% had brain metastases (one third had a solitary brain metastasis). Overall median survival was 10.4 months (95% CI, 8.1-13.6 months). The 1-, 2-, 3-, and 4-year survival rates were 44.2% (95% CI, 36.7%-51.4%), 21.9% (95% CI, 16%-28.3%), 11.6% (95% CI, 7.3%-17%), and 7.8% (95% CI, 4.2%-12.8%), respectively. On multivariate analysis, statistically significant negative prognostic factors included PS > or = 2 (hazard ratio [HR], 1.9 [95% CI, 1.1-3.28]), serum albumin of < or = 3 g/dL (HR, 1.7 [95% CI, 1.1-2.76 g/dL]), and metastases to > 1 organ (HR, 1.6 [95% CI, 1.03-2.3]). Brain, bone, and liver metastases were not found to be independent predictors of survival.
The most important prognostic determinants were PS, baseline albumin, and number of metastatic sites. Incidence of brain metastases at presentation in this population was higher than usually described. Survival rates in this cohort equal or exceed contemporary figures observed in Eastern Cooperative Oncology Group advanced NSCLC trials.
随着磁共振成像和正电子发射断层扫描在非小细胞肺癌（NSCLC）分期中的应用日益增加，该患者群体在诊断时的人口统计学特征、体能状态（PS）和转移分布正在发生变化。因此，我们重新评估了现代基线临床变量的预后意义。
我们回顾性评估了2000年10月至2003年8月期间在三级转诊中心福克斯蔡斯癌症中心接受监测的172例连续入选的41 - 89岁（中位年龄62岁）IV期NSCLC患者的病历。采用Cox比例模型对基线预后因素进行单因素和多因素分析。
中位年龄为62岁；79%的患者初诊时PS为0/1。56%的患者有单一器官转移；35%有脑转移（三分之一有孤立性脑转移）。总体中位生存期为10.4个月（95%CI，8.1 - 13.6个月）。1年、2年、3年和4年生存率分别为44.2%（95%CI，36.7% - 51.4%）、21.9%（95%CI，16% - 28.3%）、11.6%（95%CI，7.3% - 17%）和7.8%（95%CI，4.2% - 12.8%）。多因素分析显示，具有统计学意义的负面预后因素包括PS≥2（风险比[HR]，1.9[95%CI，1.1 - 3.28]）、血清白蛋白≤3g/dL（HR，1.7[95%CI，1.1 - 2.76g/dL]）以及转移至>1个器官（HR，1.6[95%CI，1.03 - 2.3]）。脑、骨和肝转移未被发现是生存的独立预测因素。
最重要的预后决定因素是PS、基线白蛋白和转移部位数量。该人群中初诊时脑转移的发生率高于通常描述的情况。该队列的生存率等于或超过东部肿瘤协作组晚期NSCLC试验中观察到的当代数据。
