[Chemotherapy of small cell bronchial cancers. Prognostic importance of complete response (1,280 patients). Groupe Petites Cellules].
OBJECTIVE
Pretherapeutic prognostic factors for patients given chemotherapy for small cell lung carcinoma have been widely studied. We evaluated response to chemotherapy in patients included in 4 multicentric trials with less restrictive entry criteria in order to determine the contribution of clinical outcome as a predictive factor.


METHODS
Pretherapeutic and therapeutic prognostic factors were assessed in 1280 patients included in 4 successive multicentric therapeutic trials on chemotherapy for small cell lung carcinoma conducted from January 1, 1983 to April 1, 1992. Logrank test for univariate analysis and Cox's stepwise method for multivariate analysis were used to evaluate the results.


RESULTS
Univariate analysis identified pretherapeutic factors as significant for prognosis: Karnofsky index (p < 0.0001), alkaline phosphatase level (p < 0.0002), white cell count (p < 0.0005), age (p = 0.0007), presence of brain metastasis (p = 0.0004), presence of liver metastasis (p = 0.03), initial extension (p = 0.04). Multivariate analysis taking into account pretherapeutic and therapeutic factors demonstrated that complete response after the second and after the sixth treatment session were predictive of longer survival (p = 0.0001). This factor was more powerful than all the pretherapeutic factors including the Karnofsky index, initial extension and brain metastasis.


CONCLUSIONS
For patients with small cell lung carcinoma, the prognostic value of early response to chemotherapy suggests that high-doses should be used starting at the first session.
Lebeau
B
B
Service de Pneumologie, Centres Hospitaliers d'Amiens, CHU.
Chastang
C
C
Schuller
M P
MP
Thiberville
L
L
Vaylet
F
F
Derenne
J P
JP
Caillaud
D
D
Muir
J F
JF
Coëtmeur
D
D
Lemarié
E
E
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use; D018288:Carcinoma, Small Cell / Q000188:drug therapy* / Q000401:mortality / Q000473:pathology; D005260:Female; D006801:Humans; D008175:Lung Neoplasms / Q000188:drug therapy* / Q000401:mortality / Q000473:pathology; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D011237:Predictive Value of Tests; D011379:Prognosis
Chimiothérapie des cancers bronchiques à petites cellules. Importance pronostique d'une réponse complète (1,280 patients). Groupe Petites Cellules.