Population Characteristics and Prognostic Factors in Metastatic Non–Small-Cell Lung Cancer: A Fox Chase Cancer Center Retrospective

Abstract

PURPOSEWith the increasing use of magnetic resonance imaging and positron emission tomography for staging non–small-cell lung cancer (NSCLC), the demographics, performance status (PS), and distribution of metastases at diagnosis in this patient population are changing. We therefore reassessed the prognostic implications of baseline clinical variables in the modern era. PATIENTS AND METHODSWe retrospectively evaluated the charts of 172 consecutive, unselected patients aged 41-89 years (median, 62 years) with stage IV NSCLC monitored at the Fox Chase Cancer Center, a tertiary referral center, between October 2000 and August 2003. Cox proportional models were used to conduct univariate and multivariate analyses of baseline prognostic factors. RESULTSMedian age was 62 years; 79% of patients were PS 0/1 at first presentation. Fifty-six percent had single organ metastasis; 35% had brain metastases (one third had a solitary brain metastasis). Overall median survival was 10.4 months (95% CI, 8.1-13.6 months). The 1-, 2-, 3-, and 4-year survival rates were 44.2% (95% CI, 36.7%-51.4%), 21.9% (95% CI, 16%-28.3%), 11.6% (95% CI, 7.3%-17%), and 7.8% (95% CI, 4.2%-12.8%), respectively. On multivariate analysis, statistically significant negative prognostic factors included PS ≥ 2 (hazard ratio [HR], 1.9 [95% CI, 1.1-3.28]), serum albumin of ≤ 3 g/dL (HR, 1.7 [95% CI, 1.1-2.76 g/dL]), and metastases to > 1 organ (HR, 1.6 [95% CI, 1.03- 2.3]). Brain, bone, and liver metastases were not found to be independent predictors of survival. CONCLUSIONThe most important prognostic determinants were PS, baseline albumin, and number of metastatic sites. Incidence of brain metastases at presentation in this population was higher than usually described. Survival rates in this cohort equal or exceed contemporary figures observed in Eastern Cooperative Oncology Group advanced NSCLC trials.