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Randomized Controlled Trial
. 2012 Sep;7(9):1361-8.
doi: 10.1097/JTO.0b013e318260e106.

Prognostic models to predict survival in non-small-cell lung cancer patients treated with first-line paclitaxel and carboplatin with or without bevacizumab

Tien Hoang  1 , Suzanne E Dahlberg, Alan B Sandler, Julie R Brahmer, Joan H Schiller, David H Johnson
Affiliations
Randomized Controlled Trial

Prognostic models to predict survival in non-small-cell lung cancer patients treated with first-line paclitaxel and carboplatin with or without bevacizumab

Tien Hoang et al. J Thorac Oncol. 2012 Sep.

Abstract

Background: To determine prognostic factors and build a model to predict 1-year overall survival (OS) and 6-month progression-free survival (PFS) in advanced non-small-cell lung cancer (NSCLC) patients treated with first-line paclitaxel and carboplatin with or without bevacizumab.

Materials and methods: We analyzed 26 pretreatment clinical variables in 850 NSCLC patients treated in the randomized Eastern Cooperative Oncology Group 4599 study. Univariate and multivariate analyses were performed to identify prognostic factors. Cox regression with 50% randomly sampled data was used to build nomograms with a prognostic score assigned to each factor. The model was validated with the remaining 50% of data.

Results: Eleven poor factors for OS (hazard ratio) were as follows: skin metastasis (4.49), body mass index less than 18.5 (2.09), increased serum lactate dehydrogenase (1.74), adrenal metastasis (1.52), performance status greater than 0 (1.45), low serum albumin (1.45), men (1.39), bone metastasis (1.39), large cell/not otherwise specified histology (1.29), mediastinal nodal metastasis (1.23), and treatment without bevacizumab (1.18). Seven poor factors for PFS were as follows: skin metastasis (3.13), treatment without bevacizumab (1.52), bone metastasis (1.41), liver metastasis (1.40), low serum albumin (1.39), performance status greater than 0 (1.21), and mediastinal nodal metastasis (1.14). Based on these factors, we built and validated two nomograms predicting 1-year OS and 6-month PFS.

Conclusion: Using our proposed models, the probability of survival with first-line paclitaxel and carboplatin with or without bevacizumab in nonsquamous NSCLC patients can be estimated. These prognostic models provide a tool for research design and clinical decision making, such as patient stratification and therapy selection.

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Figures

Figure 1
Figure 1
Prognostic Nomograms Predicting: (A) One-Year Survival; (B) Six-Month Progression Free Survival.
Figure 1
Figure 1
Prognostic Nomograms Predicting: (A) One-Year Survival; (B) Six-Month Progression Free Survival.
Figure 2
Figure 2
Comparison of Predicted Survival with Observed Survival of Quartile Groups of Patients in the Validation Set: (A) One-Year Survival; (B) Six-Month Progression Free Survival. The dotted line is the “ideal” line if there is a perfect match between predicted and observed survival. The vertical arrows represent 95% confidence intervals of observed survival.
Figure 2
Figure 2
Comparison of Predicted Survival with Observed Survival of Quartile Groups of Patients in the Validation Set: (A) One-Year Survival; (B) Six-Month Progression Free Survival. The dotted line is the “ideal” line if there is a perfect match between predicted and observed survival. The vertical arrows represent 95% confidence intervals of observed survival.
Figure 3
Figure 3
Examples of the Nomograms: (A) Predicted one-year survival of patient 1 who is a woman with large cell lung cancer (PS 30), ECOG performance status 1 (PS 35), BMI <18.5 (PS 81), bone metastasis (PS 29) and low serum albumin (PS 32). Treated with PC alone (PS 25), her total prognostic score is 232 points (30+35+81+29+32+25). If bevacizumab is added to the doublet, her total prognostic score is 207 points (30+35+81+29+32); (B) Predicted six-month PFS of patient 1. Treated with PC alone, her prognostic score is 112 points (19+27+29+37). If bevacizumab is added to the doublet, her prognostic score is 75 points (19+27+29); (C) Predicted one-year survival of patient 2 who is a woman with an adenocarcinoma of the lung with malignant effusion, otherwise having none of poor baseline factors. Treated with PC alone, her total prognostic score is 25 points. If bevacizumab is added to the doublet, her total prognostic score is 0; (D) Predicted six-month PFS of patient 2. Treated with PC alone, her prognostic score is 37 points. If bevacizumab is added to the doublet, her prognostic score is 0.
Figure 3
Figure 3
Examples of the Nomograms: (A) Predicted one-year survival of patient 1 who is a woman with large cell lung cancer (PS 30), ECOG performance status 1 (PS 35), BMI <18.5 (PS 81), bone metastasis (PS 29) and low serum albumin (PS 32). Treated with PC alone (PS 25), her total prognostic score is 232 points (30+35+81+29+32+25). If bevacizumab is added to the doublet, her total prognostic score is 207 points (30+35+81+29+32); (B) Predicted six-month PFS of patient 1. Treated with PC alone, her prognostic score is 112 points (19+27+29+37). If bevacizumab is added to the doublet, her prognostic score is 75 points (19+27+29); (C) Predicted one-year survival of patient 2 who is a woman with an adenocarcinoma of the lung with malignant effusion, otherwise having none of poor baseline factors. Treated with PC alone, her total prognostic score is 25 points. If bevacizumab is added to the doublet, her total prognostic score is 0; (D) Predicted six-month PFS of patient 2. Treated with PC alone, her prognostic score is 37 points. If bevacizumab is added to the doublet, her prognostic score is 0.
Figure 3
Figure 3
Examples of the Nomograms: (A) Predicted one-year survival of patient 1 who is a woman with large cell lung cancer (PS 30), ECOG performance status 1 (PS 35), BMI <18.5 (PS 81), bone metastasis (PS 29) and low serum albumin (PS 32). Treated with PC alone (PS 25), her total prognostic score is 232 points (30+35+81+29+32+25). If bevacizumab is added to the doublet, her total prognostic score is 207 points (30+35+81+29+32); (B) Predicted six-month PFS of patient 1. Treated with PC alone, her prognostic score is 112 points (19+27+29+37). If bevacizumab is added to the doublet, her prognostic score is 75 points (19+27+29); (C) Predicted one-year survival of patient 2 who is a woman with an adenocarcinoma of the lung with malignant effusion, otherwise having none of poor baseline factors. Treated with PC alone, her total prognostic score is 25 points. If bevacizumab is added to the doublet, her total prognostic score is 0; (D) Predicted six-month PFS of patient 2. Treated with PC alone, her prognostic score is 37 points. If bevacizumab is added to the doublet, her prognostic score is 0.
Figure 3
Figure 3
Examples of the Nomograms: (A) Predicted one-year survival of patient 1 who is a woman with large cell lung cancer (PS 30), ECOG performance status 1 (PS 35), BMI <18.5 (PS 81), bone metastasis (PS 29) and low serum albumin (PS 32). Treated with PC alone (PS 25), her total prognostic score is 232 points (30+35+81+29+32+25). If bevacizumab is added to the doublet, her total prognostic score is 207 points (30+35+81+29+32); (B) Predicted six-month PFS of patient 1. Treated with PC alone, her prognostic score is 112 points (19+27+29+37). If bevacizumab is added to the doublet, her prognostic score is 75 points (19+27+29); (C) Predicted one-year survival of patient 2 who is a woman with an adenocarcinoma of the lung with malignant effusion, otherwise having none of poor baseline factors. Treated with PC alone, her total prognostic score is 25 points. If bevacizumab is added to the doublet, her total prognostic score is 0; (D) Predicted six-month PFS of patient 2. Treated with PC alone, her prognostic score is 37 points. If bevacizumab is added to the doublet, her prognostic score is 0.
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