Prognostic factors in nonsmall cell lung cancer: insights from the German CRISP registry

Martin Metzenmacher; Frank Griesinger; Horst-Dieter Hummel; Corinna Elender; Harald Schäfer; Maike de Wit; Ulrich Kaiser; Jens Kern; Martina Jänicke; Lisa Spring; Stefan Zacharias; Anja Kaiser-Osterhues; Annika Groth; Annette Hipper; Gregor Zaun; Steffen Dörfel; Björn Güldenzoph; Lothar Müller; Jens Uhlig; Michael Thomas; Martin Sebastian; Wilfried E E Eberhardt; CRISP Registry Group

doi:10.1183/13993003.01336-2022

Prognostic factors in nonsmall cell lung cancer: insights from the German CRISP registry

Eur Respir J. 2023 Feb 2;61(2):2201336. doi: 10.1183/13993003.01336-2022. Print 2023 Feb.

Authors

Martin Metzenmacher^{1

2}, Frank Griesinger³, Horst-Dieter Hummel⁴, Corinna Elender⁵, Harald Schäfer⁶, Maike de Wit⁷, Ulrich Kaiser⁸, Jens Kern⁹, Martina Jänicke¹⁰, Lisa Spring¹⁰, Stefan Zacharias¹¹, Anja Kaiser-Osterhues¹², Annika Groth¹³, Annette Hipper¹³, Gregor Zaun¹, Steffen Dörfel¹⁴, Björn Güldenzoph¹⁵, Lothar Müller¹⁶, Jens Uhlig¹⁷, Michael Thomas¹⁸, Martin Sebastian¹⁹, Wilfried E E Eberhardt^{1

2}; CRISP Registry Group

Affiliations

¹ Department of Medical Oncology, West German Cancer Center, University Hospital Essen, Essen, Germany.
² Division of Thoracic Oncology, West German Cancer Center, University Medicine Essen - Ruhrlandklinik, Essen, Germany.
³ Department of Haematology and Oncology, University Dept Internal Medicine-Oncology, Pius-Hospital, University Medicine Oldenburg, Oldenburg, Germany.
⁴ Interdisziplinäres Studienzentrum mit ECTU/Translationale Onkologie, Comprehensive Cancer Center, Mainfranken, Universitätsklinikum Würzburg, Würzburg, Germany.
⁵ Pneumologie, Infektiologie, Internistische Intensivmedizin, Klinik Nord im Klinikum Dortmund, Dortmund, Germany.
⁶ Pneumologie, Thorakale Onkologie, Palliativmedizin, Infektiologie, SHG Kliniken Völklingen, Völklingen, Germany.
⁷ Klinik für Innere Medizin - Hämatologie, Onkologie und Palliativmedizin, Vivantes Klinikum Neukölln, Berlin, Germany.
⁸ Medizinische Klinik II, Hämatologie & Internistische Onkologie, St. Bernward Krankenhaus, Hildesheim, Germany.
⁹ Klinikum Würzburg Mitte - Standort Missioklinik, Med. Klinik mit Schwerpunkt Pneumologie, Würzburg, Germany.
¹⁰ Clinical Epidemiology and Health Economics, iOMEDICO, Freiburg, Germany.
¹¹ Biostatistics, iOMEDICO, Freiburg, Germany.
¹² Medical Department, iOMEDICO, Freiburg, Germany.
¹³ AIO-Studien-gGmbH, Berlin, Germany.
¹⁴ Onkozentrum Dresden/Freiberg, Dresden, Germany.
¹⁵ Hämatologisch-Onkologische Praxis Altona (HOPA), Hamburg, Germany.
¹⁶ Onkologie Unter Ems, Leer, Germany.
¹⁷ Praxis Dr. med. Jens Uhlig, Naunhof, Germany.
¹⁸ Department of Thoracic Oncology, Thoraxklinik, University Hospital Heidelberg and Translational, Lung Research Center Heidelberg (TLRC-H), Member of the German Center for Lung Research (DZL), Heidelberg, Germany.
¹⁹ Department of Hematology and Medical Oncology, University Hospital Frankfurt, Frankfurt, Germany.

Abstract

Introduction: Understanding prognosis, especially long-term outcome, in advanced nonsmall cell lung cancer (NSCLC) is crucial to inform patients, guide treatment and plan supportive and palliative care.

Methods: Prognostic factors influencing overall survival (OS) and progression-free survival (PFS) in 2082 patients with wild-type (WT)-NSCLC (629 M1a, 249 M1b, 1204 M1c) are reported. Patients were included in the prospective German CRISP registry recruiting in >150 centres. Analysis for pre-therapeutic factors was based on results from Cox proportional hazard models.

Results: Current M-descriptors of the Union for International Cancer Control-8 staging system were validated: M1a and M1b patients had significantly longer median time to events compared to M1c (OS/PFS 16.4/7.2 months, 17.8/6.7 months and 10.9/5.4 months, respectively). OS and PFS were influenced by number and location of metastatic organ systems. M1c and four or more metastatic organs involved had shorter OS and PFS than M1c with one to three organs (OS hazard ratio (HR) 1.69, p<0.001; PFS HR 1.81, p<0.001). M1b-liver metastases had shorter OS/PFS than M1b involving other organs (OS HR 2.70, p=0.006; PFS HR 2.48, p=0.007). Based on number of involved organs (orgsys) and liver metastases, two risk groups (low-risk: M1a, M1b-non-liver, M1c-1-3-orgsys-non-liver; high-risk: M1c-liver, M1b-liver, M1c-4+-orgsys) with significantly different prognoses could be amalgamated (median OS/PFS 14.3/6.5 months and 7.7/4.1 months, respectively). Other favourable factors were female gender and Eastern Cooperative Oncology Group stage 0, with age showing no impact. Those with T1- or N0-status were associated with longer OS than T2-4 or N2-3.

Conclusion: In this large observational dataset, we further defined factors for outcome in WT-NSCLC, including increased number of involved metastatic organ systems and liver metastases, as those with overall poorer prognosis and reduced survival chance.

Trial registration: ClinicalTrials.gov NCT02622581.

Publication types

Observational Study
Research Support, Non-U.S. Gov't

MeSH terms

Carcinoma, Non-Small-Cell Lung* / pathology
Female
Humans
Lung Neoplasms* / pathology
Male
Neoplasm Staging
Prognosis
Prospective Studies
Retrospective Studies
Risk Factors

Associated data

ClinicalTrials.gov/NCT02622581