Abstract
Prognostic factors are crucial to guide patient's selection through therapeutic decisions and outcome prediction. To investigate prognostic factors associated with improved survival in stage III non-small cell lung cancer. We retrospectively reviewed clinical data of 88stage III non-small cell lung cancer patients treated between 2010-2017. Multidisciplinary evaluation prior to therapy onset was mandatory. Univariate analyses and multivariate logistic regression were performed to identify factors associated with survival. Median follow-up was 28months, 56% of patients experienced recurrence. Median overall survival (OS) was 19months. On univariable analysis, improved OS correlated with younger age (p=0.011), better performance score (ECOG PS<2) (p<0.01), absence of weight loss (p=0.019) and smaller tumor size (≤7cm) (p=0.005). OS was improved in patients receiving therapy planned by multidisciplinary meeting compared with those who did not (p<0.01), in those with resected tumors (p=0.001), responding to therapy (neoadjuvant chemotherapy (p=0.034) and concurrent chemoradiation (p=0.001), as well as those with lower neutrophil-lymphocyte ratio (p=0.026) and lower platelet-lymphocyte ratio (p=0.003). Postoperative adjuvant therapy increased OS (64vs 24, p=0.025). Longer recurrence-free interval, locoregional failure and better perfomance status at recurrence were good prognostic factors for OS. Multivariate analysis showed that only upfront surgery followed by adjuvant therapy (hazard ratio (HR)=0.61; 95% confidence interval (CI) 0.38-0.96; p=0.034), adherence to multidisciplinary team decision (HR=0.26; 95% CI 0.15-0.47; p<0.01) and tumor size>7 cm (HR=2.31; 95% CI 1.29-4.13; p=0.005) were independent prognostic factors affecting OS. Optimal therapeutic strategy and adherence to the decision provided by the multidisciplinary evaluation of patients played an important role in stage III non-small cell lung cancer outcome.
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