Edinburgh Cancer Research Centre, University of Edinburgh, Edinburgh, UK.
Oncology, University Hospital of Herakleion, Herakleion, Crete, Greece.
Lung Cancer. 2015 Jun;88(3):304-9. doi: 10.1016/j.lungcan.2015.03.020. Epub 2015 Mar 28.
In patients with advanced incurable lung cancer deciding as to the most appropriate treatment (e.g., chemotherapy or supportive care only) is challenging. In such patients the TNM classification system has reached its ceiling therefore other factors are used to assess prognosis and as such, guide treatment. Performance status (PS), weight loss and inflammatory biomarkers (Glasgow Prognostic Score (mGPS)) predict survival in advanced lung cancer however these have not been compared. This study compares key prognostic factors in advanced lung cancer.
Patients with newly diagnosed advanced lung cancer were recruited and demographics, weight loss, other prognostic factors (mGPS, PS) were collected. Kaplan-Meier and Cox regression methods were used to compare these prognostic factors.
390 patients with advanced incurable lung cancer were recruited; 341 were male, median age was 66 years (IQR 59-73) and patients had stage IV non-small cell (n=288) (73.8%) or extensive stage small cell lung cancer (n=102) (26.2%). The median survival was 7.8 months. On multivariate analysis only performance status (HR 1.74 CI 1.50-2.02) and mGPS (HR 1.67, CI 1.40-2.00) predicted survival (p<0.001). Survival at 3 months ranged from 99% (ECOG 0-1) to 74% (ECOG 2) and using mGPS, from 99% (mGPS0) to 71% (mGPS2). In combination, survival ranged from 99% (mGPS 0, ECOG 0-1) to 33% (mGPS2, ECOG 3).
Performance status and the mGPS are superior prognostic factors in advanced lung cancer. In combination, these improved survival prediction compared with either alone.
在患有晚期不可治愈肺癌的患者中，决定最适当的治疗方法（例如，化疗或仅支持性护理）具有挑战性。在这些患者中，TNM 分类系统已经达到了上限，因此其他因素被用于评估预后并指导治疗。体能状态（PS）、体重减轻和炎症生物标志物（格拉斯哥预后评分（mGPS））可预测晚期肺癌的生存情况，但尚未对这些因素进行比较。本研究比较了晚期肺癌的关键预后因素。
招募了新诊断为晚期肺癌的患者，并收集了人口统计学、体重减轻和其他预后因素（mGPS、PS）。采用 Kaplan-Meier 和 Cox 回归方法比较这些预后因素。
共招募了 390 例晚期不可治愈肺癌患者；341 例为男性，中位年龄为 66 岁（IQR 59-73），患者为 IV 期非小细胞肺癌（n=288）（73.8%）或广泛期小细胞肺癌（n=102）（26.2%）。中位生存期为 7.8 个月。多变量分析显示，仅体能状态（HR 1.74，CI 1.50-2.02）和 mGPS（HR 1.67，CI 1.40-2.00）预测生存（p<0.001）。3 个月生存率从 ECOG 0-1 的 99%到 ECOG 2 的 74%不等，而 mGPS 则从 mGPS0 的 99%到 mGPS2 的 71%不等。联合使用时，生存率从 mGPS 0、ECOG 0-1 的 99%到 mGPS2、ECOG 3 的 33%不等。
体能状态和 mGPS 是晚期肺癌的更好的预后因素。联合使用时，与单独使用相比，这些因素提高了生存预测的准确性。
