Validation and comparison of several published prognostic systems for patients with small cell lung cancer

Abstract

The aim of the present study was to validate and compare published prognostic classifications for predicting the survival of patients with small cell lung cancer.We pooled data from phase III randomised clinical trials, and used Cox models for validation purposes and concordance probability estimates for assessing predictive ability.We included 693 patients. All the classifications impacted significantly on survival, with hazard ratios (HRs) in the range 1.57-1.68 (all p,0.0001). Median survival times were 16-19 months for the best predicted groups, while they were 6-7 months for the most poorly predicted groups. Most of the paired comparisons were statistically significant. We obtained similar results when restricting the analysis to patients with extensive disease. Multivariate Cox models for fitting survival data were also performed. The HRs for a single covariate were 8.23 (95% CI 5.88-11.69), and 9.46 (6.67-13.50), and for extensive disease were 5.60 (3.13-9.93), 12.49 (5.57-28.01) and 8. 83 (4.66-16.64). Concordance probability estimates ranged 0.55-0.65 (overlapping confidence intervals).Published classifications were validated and suitable for use at a population level. As expected, prediction at an individual level remains problematic. A specific model designed for extensivedisease patients did not appear to perform better.

Endobronchial Mucosa Invasion Predicts Survival in Patients with Small Cell Lung Cancer

“…Many studies had tried to identify the clinical and laboratory parameters to predict long-term survival in small cell lung cancer [6], [7], [13], [14]. Compatible with previous reports, our results also indicated that age [6] and extensive stage [7] were independent contributing factors for shorter survival time, while receiving chemotherapy [7] no less than 4 courses was an independent contributing factor for better outcome.…”

Combined small‐cell lung carcinoma: An institutional experience

“…While disease extent is the most reproducible prognostic factor, age, female gender, and performance status are significant in various SCLC analyses. However, validation and comparison of these prognostic factors has not led to a consensus prognostic algorithm . SCLC has typically been a disease of elderly men over the age of 70 who smoke, which is similar to the findings of our analysis .…”

Prognostic and predictive factors for lung cancer

“…Other parameters from molecular biology like BCL2 expression, p53 normal status or no overexpression of HER2 [23] have been suggested but evidence is less clear. Four different collaborative research groups attempted to construct prognostic classifications making use only of independent prognostic factors [41]. Those prognostic classifications, although including different covariates, were recently validated using external data and can be used in clinical trials for stratification purposes.…”

“…For example, the one published by the ELCWP has four groups distinguished by Karnofsky performance index, sex, disease extent and neutrophils count. In the validation series, the four groups had respective median survival times of 19, 11, 7 and 6 months [41].…”