Prognostic factors in non‐small cell lung cancer
Seminars in Surgical OncologyPublished 1 September 2003
Merrill J. Solan, Maria Werner‐Wasik
Citations36
Generate an AI Snapshot to get a quick, structured summary of this paper.
Study Snapshot
ObjectiveStudy objective
MethodsResearch methodology
PopulationPopulation studied
Sample sizeSample sizes
OutcomesStudy outcomes here
ResultsStudy results comes here
LimitationsResearch study limitations comes here
A concise AI-generated summary of the paper will appear here once you click Generate AI Snapshot.
TL;DR
The purpose of this work is to review the modern literature with regard to prognostic factors for patients with non-small-cell lung cancer taking into account ongoing advances in clinical evaluation, staging, surgery, radiation therapy, chemotherapy, and molecular biology in this widely heterogeneous patient population.
Abstract
Identification of prognostic factors is critical in optimizing treatment for patients with cancer. The purpose of this work is to review the modern literature with regard to prognostic factors for patients with non-small-cell lung cancer (NSCLC) taking into account ongoing advances in clinical evaluation, staging, surgery, radiation therapy, chemotherapy, and molecular biology in this widely heterogeneous patient population.
Keywords
Medicine
Journal of Chronic DiseasesA new method of classifying prognostic comorbidity in longitudinal studies: Development and validation
49,938 Citations1987Mary E. Charlson, Peter Pompei +2 more
The method of classifying comorbidity provides a simple, readily applicable and valid method of estimating risk of death fromComorbid disease for use in longitudinal studies and further work in larger populations is still required to refine the approach.
AJCC Cancer Staging Manual
6,380 Citations2002American Joint Committee on Cancer, Greene, Frederick L. +4 more
Purposes and Principles of Cancer Staging and End-Results Reporting are explained.
CHEST JournalRevisions in the International System for Staging Lung Cancer
4,598 Citations1997Clifton F. Mountain
Analysis of a collected database representing all clinical, surgical-pathologic, and follow-up information for 5,319 patients treated for primary lung cancer confirmed the validity of the TNM and stage grouping classification schema.
BMJChemotherapy in non-small cell lung cancer: a meta-analysis using updated data on individual patients from 52 randomised clinical trials
2,850 Citations1995Non-small Cell Lung Cancer Collaborative Group
The results of this meta-analysis suggest that chemotherapy may have a role in treating non-small cell lung cancer, and reached conventional levels of significance when used with radical radiotherapy and with supportive care.
Journal of the American Geriatrics SocietyCUMULATIVE ILLNESS RATING SCALE
2,315 Citations1968Bernard S. Linn, Margaret W. Linn +1 more
A Cumulative Illness Rating Scale, designed to meet the need for a brief, comprehensive and reliable instrument for assessing physical impairment, has been developed and tested and is well suited to a variety of research uses.
Journal of Clinical OncologyConcurrent cisplatin/etoposide plus chest radiotherapy followed by surgery for stages IIIA (N2) and IIIB non-small-cell lung cancer: mature results of Southwest Oncology Group phase II study 8805.
863 Citations1995Kathy S. Albain, Valerie W. Rusch +8 more
The strongest predictor of long-term survival after thoracotomy was absence of tumor in the mediastinal nodes at surgery, and this trimodality approach was feasible in this Southwest Oncology Group (SWOG) study.
Journal of Clinical OncologySurvival determinants in extensive-stage non-small-cell lung cancer: the Southwest Oncology Group experience.
736 Citations1991Kathy S. Albain, John J. Crowley +2 more
The results suggest the need to modify the stage IV category in NSCLC and suggest that although several factors were independent variables in the Cox models, three important prognostic subgroups were easily defined through RPA.
CHEST JournalPrognostic Factors in Non-small Cell Lung Cancer
571 Citations2002Michael Brundage, Diane Davies +1 more
While the breadth of prognostic factors studied in the literature is extensive, the scope of factors evaluated in individual studies is inappropriately narrow and individual studies are typically statistically underpowered and remarkably heterogeneous with regard to their conclusions.
Radiotherapy and OncologyContinuous, hyperfractionated, accelerated radiotherapy (CHART) versus conventional radiotherapy in non-small cell lung cancer: mature data from the randomised multicentre trial
481 Citations1999Michele I. Saunders, Stanley Dische +4 more
This trial shows that control of local tumour can lead to an improvement in long term survival and demonstrates the importance of cellular repopulation as a cause of failure in the radiotherapy of NSCLC.
Journal of Clinical OncologyClinical practice guidelines for the treatment of unresectable non-small-cell lung cancer. Adopted on May 16, 1997 by the American Society of Clinical Oncology.
354 Citations1997
These guidelines are intended for use by oncologists in the care of patients outside of clinical trials and underwent external review by selected physicians and a cancer quality-of-life expert, by Health Services Research Committee members, and by the ASCO Board of Directors.
Journal of Clinical OncologyPotential impact on survival of improved tumor downstaging and resection rate by preoperative twice-daily radiation and concurrent chemotherapy in stage IIIA non-small-cell lung cancer.
273 Citations1997Noah C. Choi, Robert W. Carey +7 more
Conurrent chemoradiotherapy using twice-daily radiation is an effective induction regimen that resulted in 67% tumor downstaging, and an encouraging 37% 5-year survival rate, and the degree of tumor downStaging may be a useful intermediate end point for survival benefit in stage IIIA (N2) NSCLC.
CancerPrognostic factors in patients with resected stage I non-small cell lung cancer. A report from the Lung Cancer Study Group
273 Citations1984Mitchell H. Gail, Robert T. Eagan +12 more
G prognostic information on recurrence and survival for resected Stage I lung cancer patients with squamous cell carcinoma, adenocarcinoma or large cell carcinomas is presented.
The Annals of Thoracic SurgeryNodal stage after induction therapy for stage IIIA lung cancer determines patient survival
250 Citations2000Raphael Bueno, William G. Richards +5 more
Patients with N2-positive NSCLC whose nodal disease is eradicated after neoadjuvant therapy and surgery enjoy significantly improved cancer-free survival; however, patients who are not downstaged do not benefit from surgical resection.
International Journal of Radiation Oncology*Biology*PhysicsRadiation therapy in the management of medically inoperable carcinoma of the lungs: Results and implications for future treatment strategies
244 Citations1992Daniel E. Dosoretz, Michael J. Katin +12 more
It is concluded that radical radiation therapy is an effective treatment for small tumors when treated to doses of 65 Gray or more, especially for T1 tumors.
International Journal of Radiation Oncology*Biology*PhysicsGross tumor volume, critical prognostic factor in patients treated with three-dimensional conformal radiation therapy for non-small-cell lung carcinoma
233 Citations2002Jeffrey D. Bradley, Nantaken Ieumwananonthachai +5 more
GTV as determined by CT and 3D-CRT planning is highly prognostic for overall and cause-specific survival and local tumor control and may be important in stratification of patients in prospective therapy trials.
The Annals of Thoracic SurgeryResection of adrenal metastases from non-small cell lung cancer: a multicenter study
215 Citations2001Henri Porte, Joëlle Siat +6 more
The possibility of long-term survival after resection of isolated adrenal metastasis from NSCLC is confirmed, but no clinical or pathologic criteria were detected to identify patients amenable to potential cure.
International Journal of Radiation Oncology*Biology*PhysicsResults of radical radiation therapy in clinical stage I, technically operable non-small cell lung cancer
202 Citations1988Bruce G. Haffty, Neal Goldberg +3 more
This group of clinical Stage I lung cancer patients is understaged by modern criteria since the majority of patients did not have thoracic CT scans and staging was based on fairly limited clinical and radiographic studies.
International Journal of Radiation Oncology*Biology*PhysicsRecursive partitioning analysis of 1999 radiation therapy oncology group (RTOG) patients with locally-advanced non–small-cell lung cancer (LA-NSCLC): Identification of five groups with different survival
201 Citations2000Maria Werner‐Wasik, Charles Scott +7 more
Cisplatinum-based CT improves survival, for excellent prognosis of LA-NSCLC patients, over RT alone, and the presence of a malignant pleural effusion is a major negative prognostic factor for survival.
International Journal of Radiation Oncology*Biology*PhysicsDose, volume, and tumor control prediction in primary radiotherapy of non-small-cell lung cancer
201 Citations2002Jochen Willner, Kurt Baier +3 more
Tumor volume is an important predictor of local control in NSCLC and is found to be independent and significant prognostic factors for survival in multivariate analysis.
International Journal of Radiation Oncology*Biology*PhysicsComorbidity and KPS are independent prognostic factors in stage I non-small-cell lung cancer
200 Citations2002S. Firat, Michael Bousamra +2 more
The presence of significant comorbidity and KPS of <70 are both important prognostic factors, but were found to be independent of each other in Stage I NSCLC, and recommended when analyzing the prognostic effects of tumor or treatment-related factors on OS.
International Journal of Radiation Oncology*Biology*PhysicsComorbidity 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
192 Citations2002S. Firat, Roger W. Byhardt +1 more
Multivariate analysis with clinical stage, KPS, and comorbidity (severity index) of all patients showed that a KPS 2 were independently associated with inferior OS; clinical tumor stage was not found to be an independent prognostic factor.
CHEST JournalSurgical Management of Non-small Cell Lung Cancer With Synchronous Brain Metastases
191 Citations2001P. Bonnette, Philippe Puyo +5 more
It seems legitimate to proceed with lung resection after complete resection of a single brain metastasis, at least in patients with an adenocarcinoma and a small lung tumor and without abnormal mediastinal lymph nodes seen on the CT scan or during mediastinoscopy.
Journal of Surgical OncologyLung cancer classification: The relationship of disease extent and cell type to survival in a clinical trials population
177 Citations1987Clifton F. Mountain, John M. Lukeman +6 more
The end results study provides some insight regarding the biological behavior of squamous cell carcinoma and adenocarcinoma of the lung in terms of the anatomic extent of disease at the time of apparent complete resection.
MedicineA Clinical-Severity Staging System for Patients with Lung Cancer
154 Citations1990Alvan R. Feinstein, Carolyn K. Wells
The current research was done to develop a standard system of taxonomy (or "staging") for the prognostic impact of clinical distinctions in patients with primary lung cancer.
CancerConventional clinicopathologic prognostic factors in surgically resected nonsmall cell lung carcinoma
135 Citations1999Kenji Suzuki, Kanji Nagai +5 more
The authors evaluated 18 conventional clinicopathologic prognostic factors in each pathologic stage for resected nonsmall cell lung carcinoma, finding none to have greater prognostic impact than the pathologic TNM staging system.
International Journal of Radiation Oncology*Biology*PhysicsThe benefit of treatment intensification is age and histology-dependent in patients with locally advanced non-small cell lung cancer (NSCLC): a quality-adjusted survival analysis of radiation therapy oncology group (RTOG) chemoradiation studies
127 Citations1999Benjamin Movsas, Charles Scott +11 more
Quality-adjusted survival analysis suggests that there is a critical relationship between the type of histology and its optimal treatment, age and the ability to tolerate intensive therapy, and the need to reduce lung and upper GI toxicities.
International Journal of Radiation Oncology*Biology*PhysicsAssessment of lung cancer response after nonoperative therapy: tumor diameter, bidimensional product, and volume. A serial ct scan-based study
122 Citations2001Maria Werner‐Wasik, Ying Xiao +3 more
The purpose of this analysis is to investigate whether tumor largest dimension, bidimensional tumor product, and volume correlate with each other in evaluating tumors of patients with locally advanced non-small-cell lung cancer (NSCLC).
International Journal of Radiation Oncology*Biology*PhysicsRadiotherapy alone in technically operable, medically inoperable, early-stage (I/II) non-small-cell lung cancer
120 Citations2002Branislav Jeremić, Johannes Claßen +1 more
High-dose, curative RT is an effective treatment modality in technically operable, but medically inoperable, patients with early-stage NSCLC and local failure is the predominant pattern.
Journal of Thoracic and Cardiovascular SurgeryBlood vessel invasion by tumor cells predicts recurrence in completely resected T1 N0 M0 non-small-cell lung cancer
118 Citations1993Paolo Macchiarini, Gabriella Fontanini +6 more
The results provide a rationale for effective systemic adjuvant treatment in completely resected T1 N0 M0 non-small-cell lung cancer tailored to the individual patients' risk of development of recurrent non- Small Cell lung cancer.
The Annals of Thoracic SurgeryIdentification of prognostic factors determining risk groups for lung resection
114 Citations2000Alain Bernard, L Ferrand +4 more
In a prospective study, a practical, easy-to-use risk group system of lung resection is proposed as a tool to aid the decision to perform lung resections.
CHEST JournalImplications of Staging in Lung Cancer
112 Citations1997Tsuguo Naruke, Ryosuke Tsuchiya +3 more
Only a few modifications will be required for the TNM staging system, which at present accurately reflects the prognosis of patients with lung cancer and is helpful in determining treatment.
International Journal of Radiation Oncology*Biology*PhysicsRadical radiotherapy for early nonsmall cell lung cancer
108 Citations1995Peter Graham, Val Gebski +2 more
Highly selected subsets of patients suitable for treatment with radiotherapy can be defined equally as well as highly selected subset of patients can be selected for surgery indicating that the treatment of nonsmall cell lung cancer, particularly in older patients without comorbidity should not automatically be by a surgical approach.
CancerNeuroendocrine differentiation is an independent prognostic factor in chemotherapy-treated nonsmall cell lung carcinoma
107 Citations1996Jeffrey T. Schleusener, Henry D. Tazelaar +7 more
Neuroendocrine differentiation can be identified in 10–30% of patients with nonsmall cell lung carcinoma by immunohistochemical or electron microscopic techniques, but its clinical significance is not well established.
CancerBlood vessel and lymphatic vessel invasion in resected nonsmall cell lung carcinoma: Correlation with TNM stage and disease free and overall survival
103 Citations1996J.-M. Bréchot, Sylvie Chevret +6 more
The objective of this prospective study was to assess in 96 patients with resected nonsmall cell lung carcinoma the prevalence of both blood and lymphatic vessel invasion according to stage, as well as their prognostic value for disease free and overall survival.
CancerInfluence of cell type on failure pattern after irradiation for locally advanced carcinoma of the lung
94 Citations1979James D. Cox, Raymond Yesner +2 more
Clinical and autopsy data suggest the need for aggressive treatment of the local tumor in all cell types, and systemic therapy for small cell carcinoma and large cell and adenocarcinoma.
Lung CancerPredictive factors in radiotherapy for non-small cell lung cancer: present status
91 Citations2001Noah C. Choi, Michaël Baumann +5 more
Current data indicate that there is a dose-response relationship between radiation dose and local tumor control, and also between local tumors control and survival in stage III NSCLC.
Clinics in Chest MedicineStaging classification of lung cancer: A Critical Evaluation
89 Citations2002Clifton F. Mountain
The International System for Staging Lung Cancer has been validated as a prognostic index and questioned regarding the implications of factors that require further study.
CancerPrognostic significance of tumoral angiogenesis in completely resected late stage lung carcinoma (Stage IIIA-N2): Impact of adjuvant therapies in a subset of patients at high risk of recurrence
70 Citations1996Carlo Alberto Angeletti, Marco Lucchi +6 more
Microvessel count, as a measure of tumor angiogenesis, has been significantly correlated with metastatic disease in cutaneous, mammary, prostatic, head and neck, and early stage lung carcinoma.
The Annals of Thoracic SurgeryEvaluation of TMN classification for lung carcinoma with ipsilateral intrapulmonary metastasis
65 Citations1999Morihito Okada, Noriaki Tsubota +3 more
The new TNM classification for PM reclassified in 1997 is considered to be less acceptable for surgical-pathologic staging than the revision in 1992 and N factor should be reflected in a staging designation.
International Journal of Radiation Oncology*Biology*PhysicsInfluence of tumor volume on survival in patients irradiated for non—small-cell lung cancer
65 Citations2002Durmuş Etiz, Lawrence B. Marks +5 more
A strong independent association between a small CT-defined TTV and prolonged survival in patients with NSCLC selected for curative/definitive RT was found.
International Journal of Radiation Oncology*Biology*PhysicsApoptosis and mitosis as prognostic factors in pathologically staged N1 nonsmall cell lung cancer
62 Citations1996R. Komaki, Takashi Fujii +6 more
T pretreatment levels of apoptosis or mitosis might be useful for predicting treatment outcome of SQ and AC/LC subsets of NSCLC when analyzed separately and for predicting metastatic incidence of AC/ LC.
CHEST JournalThe 1997 International Staging System for Non-Small Cell Lung Cancer
59 Citations1999Swan Swan Leong, Caio M. Rocha Lima +2 more
The classification of synchronous pulmonary nodules in the same lobe as the primary tumor as T4 stage IIIB may imply a poorer outcome than is warranted, while the designation of a similar stage for malignant pleural effusion may not be reflective of the very poor prognosis associated with this extent of disease.
Journal of Cancer Research and Clinical OncologyA practical prognostic index for inoperable non-small-cell lung cancer
56 Citations1997Tuija Wigren, Hanna Oksanen +1 more
The prognostic factors were so strong that multivariate analyses did not reveal the treatment selection to have any significant influence on survival, and each of the five variables has the advantage of being routinely available, and is simple enough to be used in daily clinical practice.
Radiotherapy and OncologyConfirmation of a prognostic index for patients with inoperable non-small cell lung cancer
54 Citations1997Tuija Wigren
The prognostic index derived from a group of 502 patients with inoperable stages I-IIIb non-small cell lung cancer from 1974 to 1981 is verified and can easily be used to guide management in daily clinical practice.
RadiologyNon-Small Cell Lung Cancer: Prognostic Factors in Patients Treated with Surgery and Postoperative Radiation Therapy
45 Citations1999Jason H. Lee, Mitchell Machtay +5 more
Local-regional control can be achieved with surgery and radiation therapy in approximately 80% of patients; however, the rate of distant metastasis remains unacceptably high.
Lung CancerRecursive partitioning analysis of 1592 patients on four radiation therapy oncology group studies in inoperable non-small cell lung cancer
40 Citations1997Charles Scott, William T. Sause +5 more
Survival outcome of 1592 analyzable patients on four Radiation Therapy Oncology Group (RTOG) studies in inoperable non-small cell lung cancer were studied utilizing a recursive partitioning analysis (RPA), which identified KPS as the most significant covariate.
Seminars in Surgical OncologySurgery for advanced stage lung cancer
40 Citations2000Dominique Grunenwald
The therapeutic options in non-small-cell lung cancer (NSCLC) will be clarified with a "primary surgery" sub group, including Stages I, II, and IIIA, an "induction treatment" subgroup, including Stage IIIB, and 3) a "non-surgical" subgroups, includingStages IIIC and IV.
Journal of Thoracic and Cardiovascular SurgeryProblems related to TNM staging: Patients with stage III non–small cell lung cancer
34 Citations2002Kotaro Kameyama, Cheng‐long Huang +5 more
Tumor status should be reviewed by taking into account the surgical curativity, as there is no sufficient difference in prognosis between patients with pathologic stage IIIA and IIIB disease and those with T3 and T4 disease.
International Journal of Radiation Oncology*Biology*PhysicsPredictors of subclinical nodal involvement in clinical stages I and II non-small cell lung cancer: implications in the inoperable and three-dimensional dose-escalation settings
34 Citations1999Timothy Sawyer, James A. Bonner +5 more
In inoperable non-small cell lung cancer, the patients for whom mediastinal radiation therapy may most likely be indicated are those with a positive preoperative bronchoscopy, especially with large (> 3 cm) primary tumors.
Lung CancerPre-treatment prognostic factors in patients with Stage III non-small cell lung cancer treated with hyperfractionated radiation therapy with or without concurrent chemotherapy
30 Citations1995Branislav Jeremić, Yuta Shibamoto
Prognostic factors for non-small cell lung cancer treated with hyperfractionated radiotherapy (HFX RT) with or without concurrent chemotherapy, including female gender, age, age > or = 60, KPS, and previous weight loss were associated with better prognosis.
International Journal of Radiation Oncology*Biology*PhysicsFailure of T stage to predict survival in patients with non-small-cell lung cancer treated by radiotherapy with or without concomitant chemotherapy
25 Citations2002D. Ball, Jennifer Smith +2 more
There is some evidence that T stage is an independent prognostic factor in patients with NSCLC treated surgically, but it did not appear to be of value in this series of patients treated with RT with and without concomitant chemotherapy.
CancerComparison of the radiation therapy oncology group and american joint committee on cancer staging systems among patients with non-small cell lung cancer receiving hyperfractionated radiation therapy. A report of the radiation therapy oncology group protocol 83-11
23 Citations1991Walter J. Curran, Robert E. Krisch +12 more
Although both staging systems independently predict for survival, a fusion of both Stage II/AJCC systems is the most discriminating of outcome.
International Journal of Radiation Oncology*Biology*PhysicsIs prolonged survival possible for patients with supraclavicular node metastases in non-small cell lung cancer treated with chemoradiotherapy?: analysis of the radiation therapy oncology group experience
23 Citations1999Mitchell Machtay, Wendy Seiferheld +4 more
When treated with modern chemoradiotherapy, the outcome for patients with supraclavicular metastases appears to be similar to that of other Stage IIIB patients, and SN+ patients should continue to be enrolled in trials studying aggressive cheMoradiotherapy regimens for locally advanced NSCLC.
American Journal of Clinical OncologyPrognostic Factors for Local Control in Non–Small-Cell Lung Cancer Treated With Definitive Radiation Therapy
19 Citations2002Ming Chen, Guo-Liang Jiang +5 more
The prognostic index model could predict the local control condition of NSCLC treated with radiation therapy more effectively than a single variable such as TNM staging.
American Journal of Respiratory MedicineCombined Modality Treatment of Non-Small-Cell Lung Cancer
14 Citations2003Virginie Westeel, A Depierre
Several trials that are ongoing or whose accrual was recently completed should further define the role of perioperative chemotherapy in resectable NSCLC and of trimodality treatments in advanced disease.
International Journal of Radiation Oncology*Biology*PhysicsAdverse influence of younger age on outcome in patients with non-small cell lung carcinoma (nsclc) treated with radiation therapy (rt) alone
14 Citations1992Scott H. Herbert, Walter J. Curran +5 more
The difference in distribution of histologic grade, incidence of distant failure, particularly in the brain, and poorer survival outcome among patients less than 50 may be indicative of more aggressive tumor behavior in the younger patients.
The Annals of Thoracic SurgeryPrognostic implications of microscopic proximal bronchial extension in non-small cell lung cancer
9 Citations2002Murat Kara, Erkan Di̇kmen +5 more
Microscopic proximal bronchial extension has an adverse effect on survival in non-small cell lung cancer.
CHEST JournalControversies Over UICC-TNM Classification of Non-small Cell Lung Cancer
8 Citations2002Massimiliano Paci, Giorgio Sgarbi +3 more
A diagnostic model is created that reflects as accurately as possible the progress of the lung tumor disease of the patient in question in order to arrive at a histologic definition of stages T, N2, and N3, as well as M, whatever is required and is technically feasible, before imposing a definitive therapeutic program.
Hematology/Oncology Clinics of North AmericaNONSURGICAL MANAGEMENT OF NON-SMALL-CELL LUNG CANCER
6 Citations2001William T. Sause
No good clinical evidence to date suggests that including areas of subclinical involvement will result in higher cure rates, but combination therapy consisting of concurrent chemotherapy and irradiation seems to have yielded an improvement in short-term and median survival.