Outcome and prognostic factors of palliative chemotherapy for non-small cell lung cancer patients at single institution: 2002-2011

This study is related to general and clinicopathologic characteristics of non-small cell lung cancer patients who received palliative chemotherapy, overall survival, and factors that affect the survival rates. The study subjects were 402 non-small cell lung cancer patients who received palliative chemotherapy during 10 years from January 2002 to December 2011 at a university hospital. The data were processed using an SPSS 20.0 program and survival rates were analyzed using log rank tests and Cox's proportional hazards model. Major results are as follows. 1. The total number of study patients was 402, their median age was 59 years, and their ages were distributed between 30 years and 80 years. As for the patients' distribution among age groups, 431(84.8%) patients were younger than 70 years and 61(15.2) patients were 70 years old or older. With regard to gender distribution, 259(64.4%) patients were males and 143(35.6%) patients were females with a male/female ratio of 1.81:1 meaning that the number of males was larger by 1.81 times. As for smoking histories, the number of the smoking group was 236(58.7%) and number of the non-smoking group was 145(36.1%) meaning that the number of the smoking group was larger by 1.63 times. 2. As for the study patients' clinicopathologic characteristics, 300(74.6%) patients were in the ECOG performance status (PS) 0,1 groups, 31(7.7%) patients were in the ECOG PS 2,3 groups and 71(17.7%) patients had missing values indicating that palliative chemotherapy was mainly performed in groups with good ECOG PS. As for disease stages, 15(3.7%) patients were in stage IIIA, 48(11.9%) patients were in stage IIIB, 256(63.7%)patients were in stage IV, and 83(20.6%)patients had missing values. As for histologic types, 74(18.4%) patients were squamous cell carcinoma and 328(81.6%) patients were non-squamous cell carcinoma. 3. As for palliative chemotherapy-related characteristics, 296(73.6%) patients received combination chemotherapy as first line therapy and 106(26.4%) patients received single agent chemotherapy as first line therapy. The results of lines of chemotherapy indicated that 163(40.6%) patients received first line therapy only, 124(30.8%) patients received second line therapy, and 115(28.6%) patients received third or later line of therapy. 4. In survival analysis, the median survival period of all patients was 11 months, one year overall survival was 48.3%, two year overall survival was 22.1%, three year overall survival was 12%, and five year overall survival was 3.6%. Univariate analysis showed that variables with statistical significance were sex(p<0.0001), age(p=0.013), smoking history(p<0.0001), ECOG PS(p=0.004), histologic types(p=0.009), lines of chemotherapy(p<0.0001), and disease status(primary advanced or recurrent)(p=0.010). 5. Multivariate analysis showed that sex, the number of times of drug changes, and disease status had statistically significant effects on mortality risks. The analysis with sex showed that the mortality risk of males was higher by 1.4 times than females(p=0.006) and the analysis with the number of times of changes in chemotherapy showed that the mortality risk of second line therapy was 1.8 times higher than that of third or later line of therapy and the mortality risk of first line therapy was 2.3 times higher than that of third of later line of therapy(p<0.0001). The analysis of disease status demonstrated that the mortality risk of the primary advanced lung cancer group was 1.6 times higher than that of the postoperative recurrent lung cancer group(p=0.035) Because this study was conducted with only patients in a university hospital in Suwon, the results cannot represent the characteristics of lung cancer in the entire Korea. This study has a limitation that the quality of information obtained in this study may be a little lower compared to prospective studies because this study is a retrospective study and information bias may be involved. In conclusion, the significance prognostic factors of non-small cell lung cancer patients who received palliative chemotherapy were sex, the number of times of regimen changes, and primary advanced disease status. Mortality risks were shown to be higher among males compared to females, higher in patients who received first or second line of therapy compared with those who received third or later line of therapy, and higher in the primary advanced lung cancer group compared to the postoperative recurrent lung cancer group. In terms of public health, it is considered that studies are necessary to find and treat lung cancer patients earlier along with multilateral nonsmoking policies because the prognosis of lung cancer is very poor if the disease is diagnosed at advanced status and there is no special screening test. In terms of clinical aspects, it is considered that studies of female lung cancer patients with no smoking history and studies for outcome of patients who received first line, second line, third or later line of chemotherapy should be continuously conducted.

Author dc:creator

• 정, 금숙

Contributors dc:contributor

• 이, 순영
• 보건대학원
• 201130027

• 고식적항암화학요법
• 비소세포폐암
• 생존율
• 예후인자
• palliative chemotherapy
• non-small cell lung cancer
• survival
• prognostic factors

Language dc:language

ko

Identifier

http://dcoll.ajou.ac.kr:9080/dcollection/jsp/common/DcLoOrgPer.jsp?sItemId=000000016803
000000016803

OAI identifier oai:identifier

oai:repository.ajou.ac.kr:201003/10829