Smoking and Prognostic Factors in an Observational Setting in Patients with Advanced Non-Small Cell Lung Carcinoma

Abstract

Background: This prospective observational study estimated the effect of prognostic factors, particularly continued smoking during therapy, on survival in advanced non-small cell lung cancer (NSCLC) patients receiving gemcitabine-platinum. Further, prognostic factors were used to build a survival model to improve prognosis prediction in naturalistic clinical settings.Methods: Eligibility criteria included: Stage IIIB/IV NSCLC, no prior chemotherapy, and Eastern Cooperative Oncology Group (ECOG) performance status 0 or 1. A Cox regression model was constructed and validated by randomizing patients into two datasets (Construction [C]:Validation [V]; 3:1 ratio). Country, disease stage, hypercalcemia, “N” factor, weight reduction, performance status, and superior vena cava obstruction were pre-defined variables forced into the model. Continued smoking was tested with adjustment for these variables.Results: One thousand two hundred and fourteen patients (C=891 and V=323) were enrolled. The final predictive model, established in the Construction dataset, identified four significant (p≤0.05) and independent predictors of survival, which were disease stage, performance status, gemcitabine-platinum regimen, and T-stage. Smoking during therapy was not significantly associated with survival (Hazard Ratio [95% CI]: 0.955 [0.572, 1.596], p=0.8618; versus never smokers).Conclusions: Although continued smoking during therapy was not significantly associated with shorter survival, the model developed in this study forms an evidence-based approach to assessing prognosis in advanced stage NSCLC.

Modeling the overall survival of patients with advanced-stage non-small cell lung cancer using data of routine laboratory tests

“…A positive link between smoking and unfavorable survival in lung cancer patients was noted in a large number of previous studies, although there is some controversy regarding this finding . In our study, current and former smokers exhibited a shorter survival compared with never smokers, but the results were not statistically significant (Supporting Information Table S2).…”

Characteristics of clinical N0 metastatic non-small cell lung cancer

“…This finding is compatible with our results. On the other hand, Li et al reported that N staging was not an independent prognostic factor in 1214 advanced NSCLC patients who received gemcitabine in combination with platinum, although disease stage (stage IIIB or IV), PS, gemcitabine-platinum regimen, and T stage were independent predictors of survival [19]. This discrepancy may be due to the fact that the study included both stage IIIB and stage IV patients while our study registered only stage IV patients.…”

CTLA-4 +49A>G Polymorphism Is Associated with Advanced Non-Small Cell Lung Cancer Prognosis

“…Despite chemotherapy and radiotherapy, prognosis of advanced NSCLC patients remains very poor, with the 1-, 3- and 5-year survival rates for stage III NCSLC being 54, 24 and 13%, respectively [2]. While factors such as age, clinical stage and treatment methods have been suggested as potential prognosis factors [3,4], it remains difficult to predict the survival of advanced NSCLC patients.…”