title: Prognosis in advanced lung cancer--A prospective study examining key clinicopathological factors.
abstract: 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.
authors: Edinburgh Cancer Research Centre, University of Edinburgh, Edinburgh, UK.
authors: Claribel P
authors: CP
authors: Simmons
authors: Oncology, University Hospital of Herakleion, Herakleion, Crete, Greece.
authors: Filippos
authors: F
authors: Koinis
authors: Edinburgh Cancer Research Centre, University of Edinburgh, Edinburgh, UK.
authors: Marie T
authors: MT
authors: Fallon
authors: Edinburgh Cancer Research Centre, University of Edinburgh, Edinburgh, UK.
authors: Kenneth C
authors: KC
authors: Fearon
authors: Edinburgh Cancer Research Centre, University of Edinburgh, Edinburgh, UK.
authors: Jo
authors: J
authors: Bowden
authors: European Palliative Care Research Centre, Norwegian University of Science and Technology, Trondheim, Norway.
authors: Tora S
authors: TS
authors: Solheim
authors: European Palliative Care Research Centre, Norwegian University of Science and Technology, Trondheim, Norway; The Cancer Clinic, St. Olav's Hospital, Trondheim University Hospital, Trondheim, Norway.
authors: Bjorn Henning
authors: BH
authors: Gronberg
authors: Department of Surgical Sciences, University of Glasgow, Glasgow, UK.
authors: Donald C
authors: DC
authors: McMillan
authors: Larisa General Clinic, Thessaly, Greece.
authors: Ioannis
authors: I
authors: Gioulbasanis
authors: Edinburgh Cancer Research Centre, University of Edinburgh, Edinburgh, UK; European Palliative Care Research Centre, Norwegian University of Science and Technology, Trondheim, Norway. Electronic address: barry.laird@ed.ac.uk.
authors: Barry J
authors: BJ
authors: Laird
mesh_terms: D000368:Aged; D005260:Female; D006801:Humans; D008175:Lung Neoplasms / Q000401:mortality* / Q000473:pathology*; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D011379:Prognosis; D011446:Prospective Studies; D016019:Survival Analysis; D015431:Weight Loss
keywords: CRP; Cachexia; Inflammation; Lung cancer; Performance status; Prognosis