Cancer Chemotherapy and Pharmacology

, Volume 30, Issue 1, pp 1–6

A prognostic-factor risk index in advanced non-small-cell lung cancer treated with cisplatin-containing combination chemotherapy

  • Tetsu Shinkai
  • Kenji Eguchi
  • Yasutsuna Sasaki
  • Tomohide Tamura
  • Yuichiro Ohe
  • Akira Kojima
  • Fumihiro Oshita
  • Toshimichi Miya
  • Hiroaki Okamoto
  • Kazuchiyo Iemura
  • Nagahiro Saijo
Original Articles Prognostic Factor, Chemotherapy, Non-small Cell Lung Cancer

Summary

Prognostic factors for response and survival were retrospectively evaluated in 192 previously untreated patients with advanced non-small-cell lung cancer (NSCLC) who had received either vindesine plus cisplatin or mitomycin plus vindesine plus cisplatin as initial treatment. Univariate analysis demonstrated that squamous-cell histology, early stage, and a small number of metastatic sites were favorable prognostic factors for response to chemotherapy. Multivariate analysis using Cox's proportional hazard model indicated that the number of metastatic sites was the only significant pretreatment factor for response (P=0.0005). Multivariate regression analysis revealed that the number of metastatic sites (P=0.0002), sex (P=0.0009), serum albumen levels (P=0.0018), performance status (P=0.0026) and lactic dehydrogenase values (P=0.0026) contributed independently to survival. On the basis of these five prognostic factors, a prognostic index for survival was used to define three prognostic groupings (good, intermediate, and poor) for survival (median survival, 16.5 vs 9.4 vs 4.6 months;P=0.0001). This particular regression model should aid in the design and analysis of new treatment strategies and may be useful for indirect comparisons of different studies carried out in similar patient populations.

Preview

Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.

References

  1. 1.
    Bonomi P (1986) Brief overview of combination chemotherapy in non-small-cell lung cancer. Semin Oncol 13:89Google Scholar
  2. 2.
    Brinkman GL, Coates O Jr (1963) The effect of bronchitis, smoking and occupation on ventilation. Am Rev Respir Dis 87:684Google Scholar
  3. 3.
    Cox DR (1972) Regression models and life-tables (with discussion). J R Stat Soc Ser B 34:187Google Scholar
  4. 4.
    Dearing MP, Steinberg SM, Phelps R, Anderson MJ, Mulshine JL, Ihde DC, Johnson BE (1990) Outcome of patients with small-cell lung cancer: effect of changes in staging procedures and imaging technology on prognostic factors over 14 years. J Clin Oncol 8:1042Google Scholar
  5. 5.
    Finkelstein DM, Ettinger DS, Ruckdeschel JC (1986) Long-term survivors in metastatic non-small cell lung cancer: an Eastern Cooperative Oncology Group study. J Clin Oncol 4:702Google Scholar
  6. 6.
    Ginsberg RJ (1990) Limits and perspectives of surgical resection for non-small cell lung cancer. Proceedings, IASLC Workshop on Controversies in Staging and Treatment of Locally Advanced Non Small Cell Lung Cancers, Bruges, Belgium, June 17–21Google Scholar
  7. 7.
    Harrell RE Jr, Lee KL, Matchar DB, Reichert TA (1985) Regression models for prognostic prediction: advantage, problems, and suggested solution. Cancer Treat Rep 69:1071Google Scholar
  8. 8.
    Ihde DC, Makuch RW, Carney DN, Bunn PA, Cohen MH, Matthews MJ, Minna JD (1981) Prognostic implications of stage of disease and sites of metastases in patients with small cell carcinoma of the lung treated with intensive combination chemotherapy. Am Rev Respir Dis 123:500Google Scholar
  9. 9.
    Johnston-Early A, Cohen MH, Minna JD, Paxton LM, Fossieck BE, Ihde DC, Bunn PA, Matthews MJ, Makuch R (1980) Smoking abstinence prolongs survival of small cell lung cancer patients. Proceedings, 2nd World Conference on Lung Cancer, Copenhagen, June 9–13Google Scholar
  10. 10.
    Kaplan EL, Meier P (1958) Non-parametric estimation from incomplete observations. J Am Stat Assoc 63:457Google Scholar
  11. 11.
    Klastersky J (1986) Therapy with cisplatin and etoposide for non-small-cell lung cancer. Semin Oncol 13:104Google Scholar
  12. 12.
    Miller TP, Chen TT, Coltman CA Jr, O'Bryan RM, Vance RB, Weiss GB, Fletcher WS, Stephens RL, Livingston RB (1986) Effect of alternating combination chemotherapy on survival of ambulatory patients with metastatic large-cell and adenocarcinoma of the lung. A Southwest Oncology Group study. J Clin Oncol 4:502Google Scholar
  13. 13.
    Mountain CF (1986) A new international staging system for lung cancer. Chest 89 [Suppl]:225Google Scholar
  14. 14.
    O'Connell JP, Kris MG, Gralla RJ, Groshen S, Trust A, Fiore JJ, Kelsen DP, Heelan RT, Golbey RB (1986) Frequency and prognostic importance of pretreatment clinical characteristics in patients with advanced non-small-cell lung cancer treated with combination chemotherapy. J Clin Oncol 4:1604Google Scholar
  15. 15.
    Peto R, Pike MC (1973) Conservatism of the approximation (OE)2/E in the log-rank test for survival data or tumor incidence data. Biometrics 29:579Google Scholar
  16. 16.
    Rapp E, Pater JL, Willan A, Cormier Y, Murray N, Evans WK, Hodson DI, Clark DA, Feld R, Arnold AM, Ayoub JI, Wilson KS, Latreille J, Wierzbicki RF, Hill DP (1988) Chemotherapy can prolong survival in patients with advanced non-small-cell lung cancerreport of a Canadian multicenter randomized trial. J Clin Oncol 6:633Google Scholar
  17. 17.
    Ruckdeschel JC, Finkelstein DM, Ettinger DS, Creech RH, Mason BA, Joss RA, Vogl S (1986) A randomized trial of the four most active regimens for metastatic non-small cell lung cancer. J Clin Oncol 4:14Google Scholar
  18. 18.
    Sakurai M, Shinkai T, Eguchi K, Sasaki Y, Tamura T, Miura K, Fujiwara Y, Otsu A, Horiuchi N, Nakano H, Nakagawa K, Hong W-S, Saijo N (1987) Prognostic factors in non-small cell lung cancer: multivariate analysis in the National Cancer Center Hospital (Japan). J Cancer Res Clin Oncol 113:563Google Scholar
  19. 19.
    Shinkai T, Saijo N, Tominaga K, Eguchi K, Shimizu E, Sasaki Y, Fujita J, Futami H (1985) Comparison of vindesine plus cisplatin or vindesine plus mitomycin in the treatment of advanced non-small cell lung cancer. Cancer Treat Rep 69:945Google Scholar
  20. 20.
    Shinkai T, Saijo N, Eguchi K, Sasaki Y, Tominaga K, Sakurai M, Suga J, Miyaoka H, Sano T, Keicho N, Takahashi H, Ishihara J, Tamura T, Hoshi A, Jett JR (1986) Cisplatin and vindesine combination chemotherapy for non-small cell lung cancer: a randomized trial comparing two dosages of cisplatin. Jpn J Cancer Res 77:782Google Scholar
  21. 21.
    Shinkai T, Eguchi K, Sasaki Y, Tamura T, Ohe Y, Kojima A, Oshita F, Saijo N (1991) A randomized clinical trial of vindesine plus cisplatin versus mitomycin plus vindesine and cisplatin in advanced non-small cell lung cancer. Eur J Cancer 27:571Google Scholar
  22. 22.
    Sørensen JB, Hansen HH, Dombernowsky P, Bork E, Malmberg R, Aabo K, Bødker B, Hansen M (1987) Chemotherapy for adenocarcinoma of the lung (WHO III): a randomized study of vindesine versus lomustine, cyclophosphamide and methotrexate versus all four drugs. J Clin Oncol 5:1169Google Scholar
  23. 23.
    Sørensen JB, Badsberg JH, Olsen J (1989) Prognostic factors in inoperable adenocarcinoma of the lung: a multivariate regression analysis of 259 patients. Cancer Res 49:5748Google Scholar
  24. 24.
    Stahel RA, Ginsberg R, Havemann K, Hirsch FR, Ihde DC, Jassem J, Karrer K, Maurer LH, Osterlind K, Houtte PV (1989) Staging and prognostic factors in small cell lung cancer: a consensus report. Lung Cancer 5:119Google Scholar
  25. 25.
    Stanley KE (1980) Prognostic factors for survival in patients with inoperable lung cancer. J Natl Cancer Inst 65:25Google Scholar
  26. 26.
    Walker SH, Duncan DB (1967) Estimation of the probability of an event as a function of several independent variables. Biometrika 54:167Google Scholar
  27. 27.
    Zubrod CG, Schneiderman M, Frei E, Brindley C, Gold GL, Shnider B, Oviedo R, Gorman J, Jones R, Jonsson U, Colsky J, Chalmers T, Ferguson B, Dederick M, Holland J, Selawry O, Regelson W, Lasagna L, Owens AH (1960) Appraisal of methods for the study of chemotherapy of cancer in man: comparative therapeutic trial of nitrogen mustard and triethylene thiophosphamide. J Chronic Dis 11:7Google Scholar

Copyright information

© Springer-Verlag 1992

Authors and Affiliations

  • Tetsu Shinkai
    • 1
  • Kenji Eguchi
    • 1
  • Yasutsuna Sasaki
    • 1
  • Tomohide Tamura
    • 1
  • Yuichiro Ohe
    • 1
  • Akira Kojima
    • 1
  • Fumihiro Oshita
    • 1
  • Toshimichi Miya
    • 1
  • Hiroaki Okamoto
    • 1
  • Kazuchiyo Iemura
    • 1
  • Nagahiro Saijo
    • 1
    • 2
  1. 1.Department of Medical OncologyNational Cancer Center HospitalChuo-ku, TokyoJapan
  2. 2.Pharmacology DivisionNational Cancer Center Research InstituteChuo-ku, TokyoJapan

Personalised recommendations