Skip to main content

Main menu

  • Home
  • Our journals
    • Clinical Medicine
    • Future Healthcare Journal
  • Subject collections
  • About the RCP
  • Contact us

Clinical Medicine Journal

  • ClinMed Home
  • Content
    • Current
    • Ahead of print
    • Archive
  • Author guidance
    • Instructions for authors
    • Submit online
  • About ClinMed
    • Scope
    • Editorial board
    • Policies
    • Information for reviewers
    • Advertising

User menu

  • Log in

Search

  • Advanced search
RCP Journals
Home
  • Log in
  • Home
  • Our journals
    • Clinical Medicine
    • Future Healthcare Journal
  • Subject collections
  • About the RCP
  • Contact us
Advanced

Clinical Medicine Journal

clinmedicine Logo
  • ClinMed Home
  • Content
    • Current
    • Ahead of print
    • Archive
  • Author guidance
    • Instructions for authors
    • Submit online
  • About ClinMed
    • Scope
    • Editorial board
    • Policies
    • Information for reviewers
    • Advertising

Understanding prognosis and survival outcomes in patients with early-stage non-small-cell lung cancer

Maria Torrente, Pedro A Sousa, Fabio Franco, Gracinda Guerreiro, Alexandre Sousa, Consuelo Parejo, Joao Pimentao and Mariano Provencio
Download PDF
DOI: https://doi.org/10.7861/clinmed.22-4-s38
Clin Med July 2022
Maria Torrente
AHospital Universitario Puerta de Hierro Majadahonda, Majadahonda, Spain
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
Pedro A Sousa
BUniversidade Nova de Lisboa, Lisbon, Portugal
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
Fabio Franco
AHospital Universitario Puerta de Hierro Majadahonda, Majadahonda, Spain
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
Gracinda Guerreiro
BUniversidade Nova de Lisboa, Lisbon, Portugal
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
Alexandre Sousa
BUniversidade Nova de Lisboa, Lisbon, Portugal
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
Consuelo Parejo
AHospital Universitario Puerta de Hierro Majadahonda, Majadahonda, Spain
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
Joao Pimentao
BUniversidade Nova de Lisboa, Lisbon, Portugal
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
Mariano Provencio
AHospital Universitario Puerta de Hierro Majadahonda, Majadahonda, Spain
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
  • Article
  • Figures & Data
  • Info & Metrics
Loading

Introduction

Lung cancer represents a significant global health problem, accounting for more than 1.7 million deaths worldwide in 2021.1 Despite advances in cancer treatment over the last decade, the 5-year survival rate is still around 50% for surgically resected non-small-cell lung cancer (NSCLC). Even for stage I patients, 20% showed recurrence within 5 years.2 Treatment modality, mostly dictated by stage and the patient's performance status (PS), directly determines disease survival. Adjuvant radiotherapy is no longer recommended after surgery and several recent large trials have confirmed the benefit in overall survival (OS) with adjuvant chemotherapy.3–6 Thus, the identification of patients with poor prognoses after surgery is of considerable clinical relevance.

We report the results of a study population survival analysis from patients diagnosed with early-stage NSCLC at Puerta de Hierro-Majadahonda University Hospital, a tertiary hospital in Madrid, Spain. Our objective was to determine their clinicopathological characteristics at diagnosis, analyse survival and develop a stratification model to identify poor prognosis factors.

Methods

A total of 560 patients with histological confirmation of NSCLC in early stages (I–II) were included. Statistical analysis was performed using R Software, version 4.0.5. Univariate survival analysis was performed using Kaplan–Meier curves and survival functions were compared using a log-rank test to check for differences. Statistical significance was set at p<0.05. To investigate the contribution of each characteristic in the survival time, Cox multivariate regression model was adjusted.

Results and discussion

Overall, there was a significantly greater number of men (77.5%) compared with women (22.5%). The median age at diagnosis was 60.6 years. Regarding smoking habits, 56% of the diagnosed patients were former smokers and 31% current smokers, with only 10.5% of never smokers; and 35% patients relapsed. The univariate analysis identified statistically significant differences (p<0.001) according to gender with greater survival in women, age with greater survival to youngest and smoking habits with greater survival in non-smokers (Fig 1). As for treatment, survival is strongly improved by surgery and surgery with adjuvant chemotherapy compared with radiotherapy. PS also stands as a statistically significant factor that impacts prognosis (Fig 2) along with relapse. Multivariable analysis shows that age, surgery, adjuvant chemotherapy, PS and relapse are the most significant variables, while gender, stage, comorbidities, smoking habit and radiotherapy are not statistically significant (p>0.05). Accordingly, we identified and integrated significant prognostic factors for survival in the patient cohort to build a model that could stratify patients by risk.

Fig 1.
  • Download figure
  • Open in new tab
  • Download powerpoint
Fig 1.

Survival analysis in the early stages according to gender, stage and age at diagnosis and smoking habit.

Fig 2.
  • Download figure
  • Open in new tab
  • Download powerpoint
Fig 2.

Survival analysis in the early stages according to treatment, performance status and relapse.

Conclusion

In this cohort study, patients predicted to be at a higher risk by the model were men, over 70 years old, former smokers, received radiotherapy, had a PS of 2 and had relapsed. The identified features for the low profile were being a woman, 20–50 years old, non-smoker, who underwent surgery and adjuvant chemotherapy, had a PS of 0, and no relapse. High-risk clinicopathologic features should be considered simultaneously when evaluating patients with early-stage NSCLC for improving prognosis.

Funding statement

This work was supported by the European Union Horizon 2020 Research and Innovation Program, under grant agreement Nº 875160 (Project CLARIFY).

  • © Royal College of Physicians 2022. All rights reserved.

References

  1. ↵
    1. Siegel RL
    , Miller KD, Fuchs HE, Jemal A. Cancer statistics, 2022. CA Cancer J Clin 2022;72:7–33.
    OpenUrlCrossRefPubMed
  2. ↵
    1. Uramoto H
    , Tanaka F. Recurrence after surgery in patients with NSCLC. Transl Lung Cancer Res 2014;3:242–9.
    OpenUrlCrossRef
  3. ↵
    1. Arriagada R
    , Dunant A, Pignon JP, et al. Long-term results of the international adjuvant lung cancer trial evaluating adjuvant Cisplatin-based chemotherapy in resected lung cancer. J Clin Oncol 2010;28:35–42.
    OpenUrlAbstract/FREE Full Text
  4. ↵
    1. Burdett S
    , Pignon JP, Tierney J, et al. Adjuvant chemotherapy for resected early stage non-small cell lung cancer. Cochrane Database Syst Rev 2015;3:CD011430.
    OpenUrlCrossRefPubMed
  5. ↵
    1. Pathak R
    , Goldberg SB, Canavan M, et al. Association of survival with adjuvant chemotherapy among patients with early-stage non–small cell lung cancer with vs without high-risk clinicopathologic features. JAMA Oncol 2020;6:1741–50.
    OpenUrl
  6. ↵
    1. Crinò L
    , Weder W, van Meerbeeck J, Felip E, ESMO Guidelines Working Group. Early stage and locally advanced (non-metastatic) non-small-cell lung cancer: ESMO Clinical Practice Guidelines for diagnosis, treatment and follow-up. Ann Oncol 2010;21(Suppl 5):v103–15.
    OpenUrlCrossRefPubMed
    1. Wu LL
    , Liu XX, Jiang WM, et al. Stratification of patients with stage IB NSCLC based on the 8th edition of the American Joint Committee on Cancer (AJCC) Staging Manual. Front Oncol 2020;10:571.
    OpenUrl
Back to top
Previous articleNext article

Article Tools

Download PDF
Article Alerts
Sign In to Email Alerts with your Email Address
Citation Tools
Understanding prognosis and survival outcomes in patients with early-stage non-small-cell lung cancer
Maria Torrente, Pedro A Sousa, Fabio Franco, Gracinda Guerreiro, Alexandre Sousa, Consuelo Parejo, Joao Pimentao, Mariano Provencio
Clinical Medicine Jul 2022, 22 (Suppl 4) 38-40; DOI: 10.7861/clinmed.22-4-s38

Citation Manager Formats

  • BibTeX
  • Bookends
  • EasyBib
  • EndNote (tagged)
  • EndNote 8 (xml)
  • Medlars
  • Mendeley
  • Papers
  • RefWorks Tagged
  • Ref Manager
  • RIS
  • Zotero
Share
Understanding prognosis and survival outcomes in patients with early-stage non-small-cell lung cancer
Maria Torrente, Pedro A Sousa, Fabio Franco, Gracinda Guerreiro, Alexandre Sousa, Consuelo Parejo, Joao Pimentao, Mariano Provencio
Clinical Medicine Jul 2022, 22 (Suppl 4) 38-40; DOI: 10.7861/clinmed.22-4-s38
del.icio.us logo Digg logo Reddit logo Twitter logo Facebook logo Google logo Mendeley logo
  • Tweet Widget
  • Facebook Like
  • Google Plus One

Jump to section

  • Article
    • Introduction
    • Methods
    • Results and discussion
    • Conclusion
    • Funding statement
    • References
  • Figures & Data
  • Info & Metrics

Related Articles

  • No related articles found.
  • PubMed
  • Google Scholar

Cited By...

  • No citing articles found.
  • Google Scholar

More in this TOC Section

  • A rare case report of granulomatosis with polyangiitis presenting with thrombus of the ascending aorta
  • Pancreatic cancer with multiple liver metastasis complicating multi-organ infarcts from marantic endocarditis and Trousseau's syndrome
  • Age-adjusted versus cut-off for D-dimer to exclude pulmonary embolism audit
Show more Clinical

Similar Articles

FAQs

  • Difficulty logging in.

There is currently no login required to access the journals. Please go to the home page and simply click on the edition that you wish to read. If you are still unable to access the content you require, please let us know through the 'Contact us' page.

  • Can't find the CME questionnaire.

The read-only self-assessment questionnaire (SAQ) can be found after the CME section in each edition of Clinical Medicine. RCP members and fellows (using their login details for the main RCP website) are able to access the full SAQ with answers and are awarded 2 CPD points upon successful (8/10) completion from:  https://cme.rcplondon.ac.uk

Navigate this Journal

  • Journal Home
  • Current Issue
  • Ahead of Print
  • Archive

Related Links

  • ClinMed - Home
  • FHJ - Home
clinmedicine Footer Logo
  • Home
  • Journals
  • Contact us
  • Advertise
HighWire Press, Inc.

Follow Us:

  • Follow HighWire Origins on Twitter
  • Visit HighWire Origins on Facebook

Copyright © 2021 by the Royal College of Physicians