Background: The benefits of chemotherapy in advanced lung cancer patients are well known. However, after evaluating patient eligibility, not all patients proposed for chemotherapy by multidisciplinary tumour board (MTB) actually receive it. In routine clinical practice, it is important to review the impact of this decision on patient survival and hospital cancer registry serve this function perfectly. Thus, the aim of the study was to evaluate the overall survival (OS) of advanced lung cancer patients according to delivery of initial chemotherapy between January 2010 and December 2013 at a single institution.
Methods: The study included advanced lung cancer patients (adenocarcinoma, squamous cell lung cancer, small-cell lung cancer; SCLC) that were proposed for initial chemotherapy by a MTB (n=483). Patients that refused chemotherapy (n=11) or failed to come to the first appointment (n=27) were excluded, resulting in a final 445 patients included. All data were retrieved from our hospital lung cancer registry.
Results: As expected, patients receiving chemotherapy (361/445; 81%) had a significantly longer mOS (9.6 vs. 1.7 mo; log-rank, P<0.001). This effect sustained across all tumour histologies (11.0 vs. 1.8 mo for adenocarcinoma; 8.8 vs. 2.3 mo for squamous; 8.9 vs. 0.9 mo for SCLC; all log-rank, P<0.001). Also in multivariate analysis chemotherapy proved to be a strong independent factor (Cox-regression, P<0.001) alongside with tumour histology and performance status (PS) but not Charleson comorbidity index (CCI). Of note, this slightly differed from the factors revealed by logistic regression to be independently associated with chemotherapy delivery: patients with squamous histology (P<0.001), a poorer PS, as judged by the treating oncologist at the time of evaluation (P<0.001), and higher CCI (P=0.014) less often received chemotherapy. Data for matched groups will be presented on the spot.
Conclusions: The observed benefit of chemotherapy treatment in OS is not surprising and just proves the known. The value of patient and tumour features (CCI, histology), that impact the decision on chemotherapy treatment but not OS should be reconsidered and carefully interpreted in light of the extremely poor prognosis of advanced lung cancer patients not receiving chemotherapy.
