A prospective, multicenter, phase II clinical study of concurrent chemotherapy and thoracic three-dimensional radiotherapy for stage IV non-small cell lung cancer -Impact of clinical factors on survival (PPRA-RTOG003)

Abstract

Objective To investigate the impact of clinical factors on survival in patients receiving concurrent chemotherapy and three-dimensional radiotherapy (3DRT) for stage IV non-small cell lung cancer (NSCLC). Methods A total of 203 patients were enrolled in a prospective clincial study from 2008 to 2012, and among these patients, 178 patients were eligible for analysis of clinical factors. All patients were treated with platinum-based doublets chemotherapy, with a median number of chemotherapy cycles of 4(2-6 cycles) and a median dose of 3DRT of 60.3 Gy (36.0-76.5 Gy). The Kaplan-Meier method was used to calculate overall survival (OS) rates, the log-rank test was used to compare survival rates between groups, and the Cox regression model were used for multivariate analysis. Results The 1-, 2-, and 3-year overall survival rates were 56%, 16%, and 10%, respectively, and the median survival time was 13 months (95% CI=11.500-14.500). The univariate analysis showed that platelet count ≤221×109/L, neutrophil count ≤5.2×109/L, white blood cell count<7×109/L, and improvement in Karnofsky Performance Scale (KPS) after treatment significantly prolonged OS (P=0.000, 0.022, 0.003, and 0.029), and metastasis to a single organ and hemoglobin≥120 g/L tended to prolong OS (P=0.058 and 0.075). The multivariate analysis showed that white blood cell count<7×109/L, platelet count ≤221×109/L, and improvement in KPS after treatment were beneficial to OS (all P<0.05). Conclusions White blood cell count and platelet count before treatment and KPS after treatment are prognostic factors for patients with stage IV NSCLC receiving concurrent chemotherapy and 3DRT. Clinical Trial Registry ClinicalTrials.gov, registration number: ChiCTRTNC10001026. Key words: Carcinoma, non-small cell lung/three-dimensional radiotherapy; Carcinoma, non-small cell lung/concurrent chemoradiotherapy; Clinical factors; Prognosis