The impact of additional prognostic factors on survival and their relationship with the anatomical extent of disease expressed by the 6th Edition of the TNM Classification of Malignant Tumors and the proposals for the 7th Edition.
OBJECTIVE
To identify, in the international staging database of the International Association for the Study of Lung Cancer, those prognostic factors that were significant and independent of clinical stage.


METHODS
From the data submitted to the staging data base concerning 100,869 patients, cases were selected for which all the following variables were available: clinical stage, age, gender, performance status (PS), and histologic cell types. For non-small cell lung cancer (NSCLC), 12,428 patients were assessable, and for SCLC, 6609 patients were available for this study. Methods used were Cox regression analyses and recursive partitioning and amalgamation analyses.


RESULTS
PS appeared to be a very important prognostic factor for survival in addition to clinical stage. Age and gender were other independent significant variables; For NSCLC and SCLC separately, recursive partitioning and amalgamation allowed the identification of four groups of patients with differing prognoses. In advanced NSCLC (stage IIIB / IV), some routine laboratory tests (mainly white blood cells and hypercalcaemia) were also found to be significant prognostic variables. In SCLC, albumin was an independent biologic prognostic factor.


CONCLUSIONS
In addition to stage, PS and, to a lesser extent, age and gender seem to be important prognostic factors for survival in lung cancer. Although this data was obtained from the largest series ever used for such an analysis in lung cancer, these prognostic factors and models require confirmation in the prospective study already planned by the International Association for the Study of Lung Cancer Lung Cancer Staging Project.
Sculier
Jean-Paul
JP
Institut Jules Bordet, Université Libre de Bruxelles (ULB), Brussels, Belgium. sculier@bordet.be
Chansky
Kari
K
Crowley
John J
JJ
Van Meerbeeck
Jan
J
Goldstraw
Peter
P
D000367:Age Factors; D002289:Carcinoma, Non-Small-Cell Lung / Q000401:mortality / Q000473:pathology*; D018288:Carcinoma, Small Cell / Q000401:mortality / Q000473:pathology*; D005260:Female; D006801:Humans; D007391:International Cooperation; D008175:Lung Neoplasms / Q000401:mortality / Q000473:pathology*; D008207:Lymphatic Metastasis; D008297:Male; D009361:Neoplasm Invasiveness / Q000473:pathology; D009367:Neoplasm Staging / Q000592:standards*; D017410:Practice Guidelines as Topic; D011237:Predictive Value of Tests; D011379:Prognosis; D016016:Proportional Hazards Models; D012042:Registries; D012680:Sensitivity and Specificity; D012737:Sex Factors; D016019:Survival Analysis