Small-cell carcinoma of the lung: derivation of a prognostic staging system.

Abstract

Retrospective data on 22 pretreatment attributes were evaluated in 614 patients with small-cell carcinoma of the lung (SCCL). The series included 284 patients with limited disease (LD) and 328 patients with extensive disease (ED) managed between 1974 and 1986. Prognostic factors were evaluated by univariate analysis and by the Cox multivariate regression model. Recursive partition and amalgamation algorithm (RECPAM), two clustering methods well suited for obtaining strata and adapted for censoring survival data, were developed and used in the formulation of a new prognostic staging system. In univariate analysis, prognosis was significantly influenced by extent of disease (DE), the number of metastatic sites, and the detection of mediastinal spread in LD. Poor performance status (PS), male sex, and advanced age were negatively correlated with survival, as were increased serum levels of alkaline phosphates (AP), lactate dehydrogenase (LDH), carcinoembryonic antigen (CEA), total WBC count (WBCC), and low platelet count and low serum sodium. The Cox model identified plasma LDH and mediastinal spread as the only significant factors in LD; the influence of PS, number of metastatic sites, bone metastasis, brain metastasis, and platelet count were identified as significant in ED. The RECPAM model identified four distinct risk groups defined in a classification tree by the following eight attributes: DE, PS, serum AP, serum LDH, mediastinal spread, sex, WBCC, and liver metastasis. The four groups were distinguished by median survival times of 59, 49, 35, and 24 weeks, respectively (P = .0001). Interactions among prognostic factors are emphasized in the RECPAM classification model as evidenced by reassignment of patients across conventional staging barriers into alternate prognostic groups. The advantages of using RECPAM over the more conventional Cox regression techniques for a new staging system are discussed.

Progress in the management and outcome of small-cell lung cancer in a French region from 1981 to 1994

“…Third, elderly patients are less likely to be treated aggressively than younger patients (Dajczman et al, 1996). It appears that when the elderly receive the same type of treatment as younger people do, age is not a prognostic factor (Sagman et al, 1991). The importance of appropriate treatment for the elderly is also supported by our finding that age was not significant after adjustment for treatment.…”

“…LDH is now recognized as an important prognostic factor (Albain et al, 1990;Sagman et al, 1991;Maestu et al, 1997;Quoix et al, 2000). We could not assess it in our multivariate analysis because of the number of missing values.…”

“…Some authors report the prognostic importance of the number of metastatic sites (Maurer and Pajak, 1981;Spiegelman et al, 1989;Sagman et al, 1991). We did not study this because this number depended on the number of imaging procedures.…”

“…Performance status (PS) of patients is a major prognostic factor (Spiegelman et al, 1989;Albain et al, 1990;Rawson and Peto, 1990), especially for ED patients (Sagman et al, 1991). We could not study its prognostic role, however, because it was systematically recorded only for patients in clinical trials.…”

Identical chemotherapy schedules given on and off trial protocol in small cell lung cancer response and survival results

“…Clinical factors including performance status, disease stage, serum sodium, liver function tests, lactate dehydrogenase are important prognostic survival indicators in SCLC. In order to identify patients with differing prognoses and risk of early death, these factors have been combined in scoring systems (Sagman et al, 1991;Thatcher et al, 1995;Lassen et al, 1995).…”