Clinical factors influencing long-term survival in a real-life cohort of early stage non-small-cell lung cancer patients in Spain

Maria Torrente; Pedro A Sousa; Gracinda R Guerreiro; Fabio Franco; Roberto Hernández; Consuelo Parejo; Alexandre Sousa; José Luis Campo-Cañaveral; João Pimentão; Mariano Provencio

doi:10.3389/fonc.2023.1074337

Clinical factors influencing long-term survival in a real-life cohort of early stage non-small-cell lung cancer patients in Spain

Front Oncol. 2023 Feb 23:13:1074337. doi: 10.3389/fonc.2023.1074337. eCollection 2023.

Affiliations

¹ Department of Medical Oncology, Puerta de Hierro-Majadahonda University Hospital, Madrid, Spain.
² Faculty of Health Sciences, Francisco de Vitoria University, Madrid, Spain.
³ Department of Electrical Engineering, NOVA School of Science and Technology, Universidade Nova de Lisboa, Lisbon, Portugal.
⁴ Department of Mathematics and CMA, NOVA School of Science and Technology, Universidade Nova de Lisboa, Lisbon, Portugal.
⁵ Department of Thoracic Surgery, Puerta de Hierro-Majadahonda University Hospital, Madrid, Spain.

Abstract

Background: Current prognosis in oncology is reduced to the tumour stage and performance status, leaving out many other factors that may impact the patient´s management. Prognostic stratification of early stage non-small-cell lung cancer (NSCLC) patients with poor prognosis after surgery is of considerable clinical relevance. The objective of this study was to identify clinical factors associated with long-term overall survival in a real-life cohort of patients with stage I-II NSCLC and develop a prognostic model that identifies features associated with poor prognosis and stratifies patients by risk.

Methods: This is a cohort study including 505 patients, diagnosed with stage I-II NSCLC, who underwent curative surgical procedures at a tertiary hospital in Madrid, Spain.

Results: Median OS (in months) was 63.7 (95% CI, 58.7-68.7) for the whole cohort, 62.4 in patients submitted to surgery and 65 in patients submitted to surgery and adjuvant treatment. The univariate analysis estimated that a female diagnosed with NSCLC has a 0.967 (95% CI 0.936 - 0.999) probability of survival one year after diagnosis and a 0.784 (95% CI 0.712 - 0.863) five years after diagnosis. For males, these probabilities drop to 0.904 (95% CI 0.875 - 0.934) and 0.613 (95% CI 0.566 - 0.665), respectively. Multivariable analysis shows that sex, age at diagnosis, type of treatment, ECOG-PS, and stage are statistically significant variables (p<0.10). According to the Cox regression model, age over 50, ECOG-PS 1 or 2, and stage ll are risk factors for survival (HR>1) while adjuvant chemotherapy is a good prognostic variable (HR<1). The prognostic model identified a high-risk profile defined by males over 71 years old, former smokers, treated with surgery, ECOG-PS 2.

Conclusions: The results of the present study found that, overall, adjuvant chemotherapy was associated with the best long-term OS in patients with resected NSCLC. Age, stage and ECOG-PS were also significant factors to take into account when making decisions regarding adjuvant therapy.

Keywords: early stage; long-term survival; non-small cell lung cancer; prognostic model; risk stratification.

Grants and funding

This work was supported in part by CLARIFY project, within European Union’s Horizon 2020 Research and Innovation Programme under grant agreement No. 875160; and Centro de Matematica e Aplicaçoes, UID (MAT/00297/2020), Portuguese Foundation of Science and Technology.