title: Clinicopathological features and outcomes in advanced nonsmall cell lung cancer with tailored therapy.
abstract: BACKGROUND
  Lung cancer is an important cause of cancer-related deaths worldwide. There is an increasing incidence of lung cancer in never smokers and a shift of histology from squamous cell to adenocarcinoma globally in the recent past. Data on treatment outcomes with newer platinum doublets is scant from India.
  
  
  OBJECTIVE
  To study the clinicopathological features, response rates (RRs), progression-free survival (PFS), overall survival (OS), and the 1, 2, and 3 years survival, in patients with advanced nonsmall cell lung cancer (NSCLC).
  
  
  METHODS
  Data of all patients who received chemotherapy for Stage IIIB and IV NSCLC between January 2010 and June 2014 were retrospectively analyzed.
  
  
  METHODS
  Univariate analysis for OS was done by plotting Kaplan-Meier curves and the log-rank test was used to calculatePvalues. Logistic regression analysis for OS was carried out using MedCalc statistical software.
  
  
  RESULTS
  A total of 353 patients received chemotherapy. Of these, 256 were evaluable for outcome parameters. The median age at presentation was 58 years with a male:female ratio of 2.53:1. The smoker:nonsmoker ratio was 1:1. Adenocarcinomatous histology was the most common both in smokers and nonsmokers reported in 70.8% patients. Epidermal growth factor receptor (EGFR) mutation and echinoderm microtubule-associated protein-like 4-anaplastic lymphoma kinase translocation were seen in 35% and 3% of patients, respectively. The RR, median PFS, OS, 1, 2, and 3 years survival were 80%, 8 months, 12.1 months, 51.5%, 12.7%, and 4.2%, respectively. There was no significant survival difference among the treatment regimen used but the response to I line chemotherapy impacted survival. Female gender, performance status, and nonsquamous histology were significant predictors of OS (P= 0.0443,P= 0.0003,P= 0.048, respectively).
  
  
  CONCLUSIONS
  There was an increase in the incidence of nonsmokers. Adenocarcinoma was the most common histology in both smokers and nonsmokers. Treatment outcomes in advanced lung cancer were better compared to the past with the advent of newer platinum doublets and EGFR tyrosine kinase inhibitors. The response to first-line chemotherapy significantly impacts outcomes in advanced NSCLC.
authors.affiliation: Department of Medical Oncology, Nizam's Institute of Medical Sciences, Hyderabad, Telangana, India.
authors.forename: Stalin
authors.initials: S
authors.lastname: Bala
authors.affiliation: Department of Medical Oncology, Nizam's Institute of Medical Sciences, Hyderabad, Telangana, India.
authors.forename: Sadashivudu
authors.initials: S
authors.lastname: Gundeti
authors.affiliation: Department of Medical Oncology, Nizam's Institute of Medical Sciences, Hyderabad, Telangana, India.
authors.forename: Vijay Gandhi
authors.initials: VG
authors.lastname: Linga
authors.affiliation: Department of Medical Oncology, Nizam's Institute of Medical Sciences, Hyderabad, Telangana, India.
authors.forename: Lakshmi Srinivas
authors.initials: LS
authors.lastname: Maddali
authors.affiliation: Department of Medical Oncology, Nizam's Institute of Medical Sciences, Hyderabad, Telangana, India.
authors.forename: Raghunadha Rao
authors.initials: RR
authors.lastname: Digumarti
authors.affiliation: Department of Pathology, Nizam's Institute of Medical Sciences, Hyderabad, Telangana, India.
authors.forename: Shantveer G
authors.initials: SG
authors.lastname: Uppin
keywords: Epidermal growth factor receptor; nonsmall cell lung cancer; platinum doublet; survival