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Comorbidity and Karnofksy performance score are independent prognostic factors in stage III non-small-cell lung cancer: an institutional analysis of patients treated on four RTOG studies. Radiation Therapy Oncology Group. Int J Radiat Oncol Biol Phys 2002 Oct 01;54(2):357-64

Date

09/24/2002

Pubmed ID

12243808

DOI

10.1016/s0360-3016(02)02939-5

Scopus ID

2-s2.0-0036806142 (requires institutional sign-in at Scopus site)   181 Citations

Abstract

PURPOSE: To determine the prognostic role of comorbidity in Stage III non-small cell lung cancer (NSCLC) treated definitively with radiotherapy alone.

METHODS AND MATERIALS: A total of 112 patients with clinical Stage III NSCLC (American Joint Commission on Cancer 1997) enrolled in four Radiation Therapy Oncology Group studies (83-11, 84-03, 84-07, and 88-08 nonchemotherapy arms) at a single institution were analyzed retrospectively for overall survival (OS) and comorbidity. Of the 112 patients, 105 (94%) completed their assigned radiotherapy. The median assigned dose was 50.4 Gy to the lymphatics (range 45-50.4 Gy) and 70.2 Gy to the primary tumor (range 60-79.2 Gy). Comorbidity was rated retrospectively using the Cumulative Illness Rating Scale for Geriatrics (CIRS-G) and Charlson scales. Karnofsky performance scores (KPSs) and weight loss were prospectively recorded. Because only 8 patients had a KPS of <70, these patients were combined with patients who had a KPS of 70. The OS of this group was compared with that of the patients with better KPSs (>70).

RESULTS: The median survival was 10.39 months (range 7.87-12.91). The 2-, 3-, and 5-year OS rate was 20.5%, 12.5%, and 7.1%, respectively. On univariate analysis, clinical stage (IIIA vs. IIIB) was found to be a statistically significant factor influencing OS (p = 0.026), and the histologic features, grade, tumor size as measured on CT scans, age, tobacco use, weight loss >or=5%, and total dose delivered to the primary tumor were not. A KPS of <or=70 (p = 0.001), the presence of a CIRS-G score of 4 (extremely severe; p = 0.0002), and a severity index of >2 (p <0.0001) were associated with statistically significant inferior OS. Multivariate analysis with clinical stage, KPS, and comorbidity (severity index) of all patients showed that a KPS <or=70 and severity index >2 were independently associated with inferior OS; clinical tumor stage was not found to be an independent prognostic factor.

CONCLUSION: KPS and comorbidity are important independent prognostic factors in Stage III NSCLC. Comorbidity should be included in protocols studying advanced stage NSCLC and used for stratification.

Author List

Firat S, Byhardt RW, Gore E

Authors

Selim Firat MD Professor in the Radiation Oncology department at Medical College of Wisconsin
Elizabeth M. Gore MD Professor in the Radiation Oncology department at Medical College of Wisconsin

MESH terms used to index this publication - Major topics in bold

Adult
Aged
Analysis of Variance
Carcinoma, Non-Small-Cell Lung
Carcinoma, Squamous Cell
Comorbidity
Confidence Intervals
Female
Humans
Karnofsky Performance Status
Lung Neoplasms
Male
Middle Aged
Neoplasm Staging
Prognosis
Retrospective Studies
Survival Analysis