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Clinical prognostic model for older patients with advanced non-small cell lung cancer.

ABSTRACT: BACKGROUND:Older patients with non-small cell lung cancer (NSCLC) are often not prescribed standard therapy. It is important to know which older patients would be candidates for aggressive therapy based on their prognosis, and to develop a model that can help determine prognosis. METHODS:Data on older patients (?70?years) enrolled on 38 NCI cooperative group trials of advanced NSCLC from 1991 to 2011 were analyzed. Multivariable Cox PH model was built with a stepwise selection. We derived a prognostic score using the estimated Cox PH regression coefficient. We then calculated the area under receiver operating characteristic (ROC) curve of survival in the testing set. RESULTS:The final analysis included 1467 patients, who were randomly divided into a training (n?=?963) and a testing set (n?=?504). The prognostic risk score was calculated as: 3 (if male)?+?3 (if PS?=?1)?+?8 (if PS?=?2)?+?11 (if initial stage?=?IV)?+?4 (if weight loss). Patients were classified into two prognostic groups: good (0-8) and poor (?9). The median survival in the two groups in the testing set were 13.15 (95% CI, 10.82-15.91) and 8.52?months (95% CI, 7.5-9.63), respectively. The model had area under the 1-year and 2-year ROCs (0.6 and 0.65, respectively) that were higher than existing models. CONCLUSIONS:Male gender, poor performance status, distant metastases and recent weight loss predict for poor overall survival (OS) in older patients with advanced NSCLC. This study proposes a simple prognostic model for older adults with advanced NSCLC.

SUBMITTER: Ganti AK

PROVIDER: S-EPMC7136030 | biostudies-literature | 2019 Jul

REPOSITORIES: biostudies-literature

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Clinical prognostic model for older patients with advanced non-small cell lung cancer.

Ganti Apar Kishor AK Wang Xiaofei X Stinchcombe Thomas E TE Wang Yinpeng Y Bradley Jeffrey J Cohen Harvey J HJ Kelly Karen K Paulus Rebecca R Ramalingam Suresh S SS Vokes Everett E EE Pang Herbert H

Journal of geriatric oncology 20190221 4

<h4>Background</h4>Older patients with non-small cell lung cancer (NSCLC) are often not prescribed standard therapy. It is important to know which older patients would be candidates for aggressive therapy based on their prognosis, and to develop a model that can help determine prognosis.<h4>Methods</h4>Data on older patients (≥70 years) enrolled on 38 NCI cooperative group trials of advanced NSCLC from 1991 to 2011 were analyzed. Multivariable Cox PH model was built with a stepwise selection. We ...[more]

PMID: 30797707

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Project description:Importance:Nomogram prognostic models can facilitate cancer patient treatment plans and patient enrollment in clinical trials. Objective:The primary objective is to provide an updated and accurate prognostic model for predicting the survival of advanced non-small-cell lung cancer (NSCLC) patients, and the secondary objective is to validate a published nomogram prognostic model for NSCLC using an independent patient cohort. Design:1817 patients with advanced NSCLC from the control arms of 4 Phase III randomized clinical trials were included in this study. Data from 524 NSCLC patients from one of these trials were used to validate a previously published nomogram and then used to develop an updated nomogram. Patients from the other 3 trials were used as independent validation cohorts of the new nomogram. The prognostic performances were comprehensively evaluated using hazard ratios, integrated area under the curve (AUC), concordance index, and calibration plots. Setting:General community. Main outcome:A nomogram model was developed to predict overall survival in NSCLC patients. Results:We demonstrated the prognostic power of the previously published model in an independent cohort. The updated prognostic model contains the following variables: sex, histology, performance status, liver metastasis, hemoglobin level, white blood cell counts, peritoneal metastasis, skin metastasis, and lymphocyte percentage. This model was validated using various evaluation criteria on the 3 independent cohorts with heterogeneous NSCLC populations. In the SUN1087 patient cohort, the continuous risk score output by the nomogram achieved an integrated area under the receiver operating characteristics (ROC) curve of 0.83, a log-rank P-value of 3.87e-11, and a concordance index of 0.717. In the SAVEONCO patient cohort, the integrated area under the ROC curve was 0.755, the log-rank P-value was 4.94e-6 and the concordance index was 0.678. In the VITAL patient cohort, the integrated area under the ROC curve was 0.723, the log-rank P-value was 1.36e-11, and the concordance index was 0.654. We implemented the proposed nomogram and several previously published prognostic models on an online Web server for easy user access. Conclusions:This nomogram model based on basic clinical features and routine lab testing predicts individual survival probabilities for advanced NSCLC and exhibits cross-study robustness.

Dataset Information

Clinical prognostic model for older patients with advanced non-small cell lung cancer.

Publications

Clinical prognostic model for older patients with advanced non-small cell lung cancer.

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