Therapeutic results and prognostic factors of stage III NSCLC: a population-based study in Tunisia
DOI:
https://doi.org/10.32471/exp-oncology.2312-8852.vol-43-no-1.15787Keywords:
management, NSCLC, prognosis, stage IIIAbstract
Background: Prognostic factors are crucial to guide patient’s selection through therapeutic decisions and outcome prediction. Aim: To investigate prognostic factors associated with improved survival in stage III non-small cell lung cancer. Patients and Methods: We retrospectively reviewed clinical data of 88 stage 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. Results: Median follow-up was 28 months, 56% of patients experienced recurrence. Median overall survival (OS) was 19 months. 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 (≤ 7 cm) (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 (64 vs 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. Conclusions: 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.
References
Bray F, Ferlay J, Soerjomataram I, et al. Global cancer statistics 2018: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA Cancer J Clin 2018; 68: 394–424.
International Agency for Research on Cancer. The global cancer Observatory, Tunisia. 2019; 305: 2018–9.
Postmus PE, Kerr KM, Oudkerk M, et al. Early and locally advanced non-small-cell lung cancer (NSCLC): ESMO Clinical Practice Guidelines for diagnosis, treatment and follow-up. Ann Oncol 2017; 28: iv1–21.
Eberhardt WEE, De Ruysscher D, Weder W, et al. 2nd ESMO Consensus Conference in Lung Cancer: Locally advanced stage III non-small-cell lung cancer. Ann Oncol 2015; 26: 1573–88.
Ademuyiwa FO, Johnson CS, White AS, et al. Prognostic factors in stage III non–small-cell lung cancer. Clin Lung Cancer 2007; 8: 478–82.
Urvay SE, Yucel B, Erdis E, Turan N. Prognostic factors in stage III non-small-cell lung cancer patients. Asian Pacific J Cancer Prev 2016; 17: 4693–7.
Caglar HB, Baldini EH, Othus M, et al. Outcomes of patients with stage III nonsmall cell lung cancer treated with chemotherapy and radiation with and without surgery. Cancer 2009; 115: 4156–66.
Berghmans T, Paesmans M, Sculier JP. Prognostic factors in stage III non-small cell lung cancer: A review of conventional, metabolic and new biological variables. Ther Adv Med Oncol 2011; 3: 127–38.
Gagnon B, Agulnik JS, Gioulbasanis I, et al. Montreal prognostic score: Estimating survival of patients with non-small cell lung cancer using clinical biomarkers. Br J Cancer 2013; 109: 2066–71.
Rades D, Käsmann L, Schild SE, Janssen S. A survival score for patients receiving palliative irradiation for locally advanced lung cancer. Clin Lung Cancer 2016; 17: 558–62.
Jin J, Hu K, Zhou Y, Li W. Clinical utility of the modified Glasgow prognostic score in lung cancer: A meta-analysis. PLoS One 2017; 12: 1–13.
Chermiti BAF, Ben G, Sadok BM, et al. Traitement et pronostic du cancer bronchique non à petites cellules au stade avancé. Rev Mal Respir 2014; 31: 214–20.
Kwas H, Guermazi E, Khattab A, et al. Prognostic factors of advanced stage non-small-cell lung cancer. Rev Pneumol Clin 2017; 73: 180–7.
Soussi G, Ben Alaya N, Chaouch N, Racil H. Development and validation of a prognostic index for survival in non-small cell lung cancer: Results from a Tunisian cohort study. Cancer Epidemiol 2018; 53: 111–8.
Albain KS, Crowley JJ, Turrisi AT, et al. Concurrent cisplatin, etoposide, and chest radiotherapy in pathologic stage IIIB non-small-cell lung cancer: a Southwest Oncology Group phase II study, SWOG 9019. J Clin Oncol 2002; 20: 3454–60.
Liang J, Bi N, Wu S, et al. Etoposide and cisplatin versus paclitaxel and carboplatin with concurrent thoracic radiotherapy in unresectable stage III non-small cell lung cancer: a multicenter randomized phase III trial. Ann Oncol Off J Eur Soc Med Oncol 2017; 28: 777–83.
Katakami N, Tada H, Mitsudomi T, et al. A phase 3 study of induction treatment with concurrent chemoradiotherapy versus chemotherapy before surgery in patients with pathologically confirmed N2 stage IIIA nonsmall cell lung cancer (WJTOG9903). Cancer 2012; 118: 6126–35.
Antonia SJ, Villegas A, Daniel D, et al. Overall survival with durvalumab after chemoradiotherapy in stage III NSCLC. N Engl J Med 2018; 379: 2342–50.
Bradley JD, Paulus R, Komaki R, et al. Standard-dose versus high-dose conformal radiotherapy with concurrent and consolidation carboplatin plus paclitaxel with or without cetuximab for patients with stage IIIA or IIIB non-small-cell lung cancer (RTOG 0617): a randomised, two-by-two factorial p. Lancet Oncol 2015; 16: 187–99.
Eberhardt WEE, Pöttgen C, Gauler TC, et al. Phase III study of surgery versus definitive concurrent chemoradiotherapy boost in patients with resectable stage IIIA(N2) and selected IIIB non-small-cell lung cancer after induction chemotherapy and concurrent chemoradiotherapy (ESPATUE). J Clin Oncol 2015; 33: 4194–201.
Howlader N, Noone AM, Krapcho M, et al. (eds). SEER cancer statistics review 1975-2008 National Cancer Institute SEER cancer statistics review 1975-2008 National Cancer Institute. Cancer 2011; 1992–2008.
Lachgar A, Tazi MA, Afif M, et al. Lung cancer: Incidence and survival in Rabat, Morocco. Rev Epidemiol Sante Publique 2016; 64: 391–5.
Cheng T-YD, Cramb SM, Baade PD, et al. The international epidemiology of lung cancer: latest trends, disparities, and tumor characteristics. J Thorac Oncol 2016; 11: 1653–71.
Douillard J-Y, Rosell R, De Lena M, et al. Adjuvant vinorelbine plus cisplatin versus observation in patients with completely resected stage IB-IIIA non-small-cell lung cancer (Adjuvant Navelbine International Trialist Association [ANITA]): a randomised controlled trial. Lancet Oncol 2006; 7: 719–27.
Douillard J-Y, Tribodet H, Aubert D, et al. Adjuvant cisplatin and vinorelbine for completely resected non-small cell lung cancer: subgroup analysis of the Lung Adjuvant Cisplatin Evaluation. J Thorac Oncol 2010; 5: 220–8.
Albain KS, Swann RS, Rusch VW, et al. Radiotherapy plus chemotherapy with or without surgical resection for stage III non-small-cell lung cancer: a phase III randomised controlled trial. Lancet (London, England) 2009; 374: 379–86.
Morgensztern D, Waqar S, Subramanian J, et al. Prognostic significance of tumor size in patients with stage III non–small-cell lung cancer: a surveillance, epidemiology, and end results (SEER) survey from 1998 to 2003. J Thorac Oncol 2012; 7: 1479–84.
Tong YS, Tan J, Zhou XL, et al. Systemic immune-inflammation index predicting chemoradiation resistance and poor outcome in patients with stage III non-small cell lung cancer. J Transl Med 2017; 15: 1–10.
Yılmaz U, Ozdemir O, Batum O, Ermin S. The prognostic role of neutrophil-lymphocyte ratio and platelet-lymphocyte ratio in patients with stage III non-small cell lung cancer treated with concurrent chemoradiotherapy. Indian J Cancer 2018; 55: 276.
Palomar AV, Soria-Comes T, Martin UM, Maestu MI. Prognostic impact of neutrophil-to-lymphocyte ratio (NLR) pre and post chemoradiotherapy (CRT) in stage III non-small cell lung cancer (NSCLC). Ann Oncol 2019; 30: v595.
Pan C-C, Kung P-T, Wang Y-H, et al. Effects of multidisciplinary team care on the survival of patients with different stages of non-small cell lung cancer: a national cohort study. Adusumilli PS, ed. PLoS One 2015; 10: e0126547.
Bydder S, Nowak A, Marion K, et al. The impact of case discussion at a multidisciplinary team meeting on the treatment and survival of patients with inoperable non-small cell lung cancer. Intern Med J 2009; 39: 838–41.
Leo F, Venissac N, Poudenx M, et al. Multidisciplinary management of lung cancer: how to test its efficacy? J Thorac Oncol 2007; 2: 69–72.
Downloads
Published
How to Cite
Issue
Section
License
Copyright (c) 2023 Experimental Oncology
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.
