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

Apar Kishor Ganti, Xiaofei Wang, Thomas E. Stinchcombe, Yinpeng Wang, Jeffrey Bradley, Harvey J. Cohen, Karen Kelly, Rebecca Paulus, Suresh S. Ramalingam, Everett E. Vokes, Herbert Pang

Research output: Contribution to journalArticle

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.

Original languageEnglish (US)
JournalJournal of Geriatric Oncology
DOIs
StatePublished - Jan 1 2019

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Non-Small Cell Lung Carcinoma
Survival
Weight Loss
Proportional Hazards Models
ROC Curve
Neoplasm Metastasis
Therapeutics

Keywords

  • Geriatric oncology
  • Non-small cell lung cancer
  • Older patients
  • Prognostic models
  • Survival

ASJC Scopus subject areas

  • Oncology
  • Geriatrics and Gerontology

Cite this

Ganti, A. K., Wang, X., Stinchcombe, T. E., Wang, Y., Bradley, J., Cohen, H. J., ... Pang, H. (2019). Clinical prognostic model for older patients with advanced non-small cell lung cancer. Journal of Geriatric Oncology. https://doi.org/10.1016/j.jgo.2019.02.007

Clinical prognostic model for older patients with advanced non-small cell lung cancer. / Ganti, Apar Kishor; Wang, Xiaofei; Stinchcombe, Thomas E.; Wang, Yinpeng; Bradley, Jeffrey; Cohen, Harvey J.; Kelly, Karen; Paulus, Rebecca; Ramalingam, Suresh S.; Vokes, Everett E.; Pang, Herbert.

In: Journal of Geriatric Oncology, 01.01.2019.

Research output: Contribution to journalArticle

Ganti, AK, Wang, X, Stinchcombe, TE, Wang, Y, Bradley, J, Cohen, HJ, Kelly, K, Paulus, R, Ramalingam, SS, Vokes, EE & Pang, H 2019, 'Clinical prognostic model for older patients with advanced non-small cell lung cancer', Journal of Geriatric Oncology. https://doi.org/10.1016/j.jgo.2019.02.007
Ganti, Apar Kishor ; Wang, Xiaofei ; Stinchcombe, Thomas E. ; Wang, Yinpeng ; Bradley, Jeffrey ; Cohen, Harvey J. ; Kelly, Karen ; Paulus, Rebecca ; Ramalingam, Suresh S. ; Vokes, Everett E. ; Pang, Herbert. / Clinical prognostic model for older patients with advanced non-small cell lung cancer. In: Journal of Geriatric Oncology. 2019.
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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.",
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AU - Wang, Yinpeng

AU - Bradley, Jeffrey

AU - Cohen, Harvey J.

AU - Kelly, Karen

AU - Paulus, Rebecca

AU - Ramalingam, Suresh S.

AU - Vokes, Everett E.

AU - Pang, Herbert

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AB - 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.

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