Prognostic Factors Affecting Survival in Advanced Non-Small Cell Lung Cancer Patients

The aim of this study was to analyze the survival of patients with non-small cell lung cancer (NSCLC) and to evaluate the factors of dominating prognostic influence. This prospective study includes 80 consecutive patients with advanced NSCLC who were diagnosed and treated from May 2001 to January 2003. Routine pretreatment evaluation consisted of age, performance status, stage of disease (TNM), complaints (cough, sputum discharge, dispnea, tiredness, hoarseness), weight loss during the last six months, presence of chronic obstructive pulmonary disease (COPD), hemoglobin level, white blood cell count, lymphocyte count, levels of serum albumin, prealbumin, lactate dehydrogenase (LDH), cholesterol, and transferrin, and presence of depression. Prognostic importance of each characteristic was initially evaluated by unifactorial analysis followed by multifactorial analysis using Cox Proportional Hazards Model and with the method of backward stepwise logistic regression analysis. Long-rank test with the method of Kaplan-Meier was used in univariate analysis. Median survival time was 180 days. The factors affecting survival on univariate analysis were stage IV disease, poor performance status, weight loss, a symptom score of five and more, presence of depression, an increased level of serum LDH, a low level of albumin, prealbumin and hemoglobin. Multivariate analysis revealed that stage IV disease, poor performance status, low serum albumin and prealbumin and presence of depression were independent prognostic factors on survival. Prognostic evaluation of the patients with advanced NSCLC based exclusively on TNM staging is clearly insufficient to predict the prognosis of the patients. Addition of predictive factors such as performance status, serum albumin and prealbumin levels, investigation of the presence of depression to the TNM staging procedure will result in a better prognostic assessment and an easier selection of groups for the different therapeutic approaches.