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

• Main Author: Chien-Te Li, Magdalena Marek, Salih Z Guclu, Younseup Kim, Mohamed Meshref, Shukui Qin, Zbigniew Kadziola, Kurt Krejcy, Sedat Altug
• Format: Article
• Language: English
• Published: Ivyspring International Publisher 2011-01-01
• Series: Journal of Cancer
• Online Access: http://www.jcancer.org/v02p0052.htm

<p><b>Background</b>: 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.</p><p><b>Methods</b>: 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, &#8220;N&#8221; 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.</p><p><b>Results</b>: 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&#8804;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).</p><p><b>Conclusions</b>: 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.</p>