Journal of Clinical Oncology, Vol 7, 344-354, Copyright © 1989 by American Society of Clinical Oncology
Prognostic factors in small-cell carcinoma of the lung: an analysis of 1,521 patients
D Spiegelman, LH Maurer, JH Ware, MC Perry, AP Chahinian, R Comis, W Eaton, B Zimmer and M Green
Department of Biostatistics, Harvard School of Public Health, Boston, MA 02115.
Cancer and Leukemia Group B (CALGB) accrued 1,745 patients with limited
(LD) or extensive (ED) small-cell lung cancer (SCCL) to five separate
trials between 1972 and 1986. We reviewed these data to evaluate the impact
of pretreatment prognostic factors on outcome. In multivariate analysis,
female gender was predictive of improved response (LD, P = .01; ED, P =
.04) and survival (LD, P = .01; ED, P = .02). A performance status of 0 or
1 was associated with improved response rates in both subsets, but was
statistically significant (P = .04) only for overall objective response in
LD patients. Performance status was a highly significant predictor of
survival in both LD and ED groups (P less than .001). Supraclavicular lymph
node involvement, while still LD, had a borderline unfavorable impact on
survival (P = .06) compared with a lesser extent of LD involvement. In ED
patients, a decrease in survival rates was associated with an increased
number of metastatic sites (P = .01). Changes in the patient population
were noted with time: the percentage of women increased from 21% to greater
than 35%; an increased number of metastatic sites was identified among ED
patients; mean performance status improved for both LD and ED subsets.
These trends reflect the changing demographics of lung cancer, improved
lung cancer staging, and probably lead-time bias. Response rates, overall
survival, and long-term (greater than 2-year) survival varied significantly
among the five protocols, both before and after multivariate correction for
identified prognostic variables. However, the changing character of the
study population limits the ability to determine retrospectively how much
improvements in therapy contributed to the positive changes in failure-free
survival, overall survival, and long-term survival observed in our
sequentially studied population.
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