Japan Clinical Oncology Group (JCOG) Data Center/Operations Office, National Cancer Center Hospital, Tokyo, Japan.
Nagoya University Graduate School of Medicine, Nagoya, Japan.
J Geriatr Oncol. 2018 Nov;9(6):583-588. doi: 10.1016/j.jgo.2018.04.005. Epub 2018 May 3.
The Lung Cancer Subscale (LCS) of the Functional Assessment of Cancer Therapy-Lung (FACT-L) questionnaire is commonly used for evaluating lung cancer-specific symptoms. The objective of this study was to elucidate the prognostic value of the LCS in older patients with advanced non-small cell lung cancer (NSCLC).
We conducted an integrated analysis of data from two randomized phase III trials (JCOG0207, JCOG0803/WJOG4307L) including patients aged 70 years or older with advanced NSCLC to evaluate the prognostic value of LCS scores at baseline (Aim 1) and for symptom improvement (an increase in LCS of two points or more during treatment) (Aim 2). Multivariable analyses for survival, adjusted for baseline factors, were performed using a stratified Cox regression model with treatment regimen as a stratum.
A total of 327 patients were included in the analysis for Aim 1 and 373 patients for Aim 2. Approximately 70% of patients were aged 75 or older. In Aim 1, use of descriptive statistics determined a cutoff point for baseline LCS score of 21. Multivariable analysis showed that higher baseline LCS was associated with favorable overall survival (OS) (hazard ratio [HR]: 0.68; 95% confidence interval [CI]: 0.52-0.89) and progression-free survival (HR: 0.68; 95% CI: 0.52-0.89). In Aim 2, symptom improvement was not associated with favorable OS (HR: 0.97; 95% CI: 0.72-1.23).
It is recommended to consider baseline LCS scores while determining treatment strategies for older patients with advanced NSCLC.
癌症治疗功能评估-肺（FACT-L）问卷的肺癌子量表（LCS）常用于评估肺癌特异性症状。本研究旨在阐明 LCS 在老年晚期非小细胞肺癌（NSCLC）患者中的预后价值。
我们对两项包括 70 岁及以上晚期 NSCLC 患者的随机 III 期试验（JCOG0207、JCOG0803/WJOG4307L）的数据进行了综合分析，以评估基线时 LCS 评分（目的 1）和症状改善（治疗期间 LCS 增加 2 分或更多）的预后价值（目的 2）。使用分层 Cox 回归模型，以治疗方案为分层因素，对生存进行多变量分析，调整基线因素。
共有 327 例患者用于目的 1 分析，373 例患者用于目的 2 分析。约 70%的患者年龄在 75 岁及以上。在目的 1 中，使用描述性统计确定基线 LCS 评分的截止点为 21。多变量分析显示，较高的基线 LCS 与较好的总生存（OS）（风险比[HR]：0.68；95%置信区间[CI]：0.52-0.89）和无进展生存（HR：0.68；95% CI：0.52-0.89）相关。在目的 2 中，症状改善与 OS 无相关性（HR：0.97；95% CI：0.72-1.23）。
建议在确定老年晚期 NSCLC 患者的治疗策略时考虑基线 LCS 评分。
