Age dependent prognosis in concurrent chemo-radiation of locally advanced NSCLC

Figures & data

Table I. Patients characteristics of 478 patients with NSCLC.

	< 60 y			60–69 y			> 70 y
	CRT N = 32	No-CRT N = 78	p	CRT N = 64	No-CRT N = 142	p	CRT N = 41	No-CRT N = 121	p
Gender
Female	15 (47%)	44 (57%)		25 (39%)	60 (42%)		20 (49%)	44 (36%)
Male	17 (53%)	34 (43%)	ns	39 (61%)	82 (58%)	ns	21 (51%)	77 (64%)	ns
Performance status
0	8 (25%)	24 (31%)		20 (31%)	32 (23%)		11 (24%)	28 (23%)
1	22 (69%)	45 (58%)		40 (63%)	91 (64%)		23 (56%)	68 (56%)
2#	2 (6%)	9 (12%)	ns	4 (5%)	19 (13%)	ns	7 (17%)	25 (21%)	ns
Smoking habit
Never smoker/stop ≥ 10 y	6 (19%)	9 (12%)		6 (9%)	16 (11%)		11 (27%)	34 (29%)
Stop smoking 1–10 y	8 (25%)	9 (12%)		17 (27%)	31 (22%)		12 (29%)	31 (26%)
Current smoker/stop < 1 y	18 (56%	60 (77%)	ns	41 (64%)	19 (45%)	ns	18 (44%)	55 (46%)	ns
FEV1% of normal (range)
≥ 75% normal range	21 (66%)	36 (48%)		32 (50%)	53 (37%)		19 (46%)	50 (42%)
< 75% normal range	11 (34%)	40 (52%)	ns	32 (50%)	89 (63%)	ns	22 (54%)	69 (58%)	ns
Histology
Squamous cell carcinoma	8 (25%)	33 (42%)		28 (44%)	81 (57%)		21 (51%)	63 (52%)
Adenocarcinoma	13 (41%)	32 (41%)		22 (34%)	42 (0%)		15 (37%)	39 (32%)
NSCLC other/NOS	11 (11%)	13 (17%)		14 (22%)	19 (13%)		5 (12%)	19 (16%)	ns
Stage
IIB	1 (1%)	2 (3%)		1 (2%)	7 (5%)		0 (0%)	15 (12%)
IIIA	12 (38%)	42 (54%)		30 (47%)	70 (49%)		24 (59%)	68 (56%)
IIIB	16 (50%)	29 (37%)		28 (44%)	51 (36%)		14 (34%)	26 (22%)
Recurrent disease	3 (9%)	5 (6%)	ns	5 (8%)	14 (10%)	ns	3 (7%)	12 (10%)	ns
Year of treatment
1995–2000	0 (0%)	29 (37%)		0 (0%)	38 (27%)		0 (0%)	27 (22%)
2001–2005	1 (3%)	35 (45%)		5 (8%)	57 (40%)		2 (5%)	43 (36%)
2006–2012	31 (97%)	14 (18%)	p*	59 (92%)	47 (33%)	p*	39 (95%)	51 (42%)	p*
Neoadjuvant chemotherapy
None	0 (0%)	22 (28%)		0 (0%)	44 (31%)		2 (5%)	72 (60%)
Neoadjuvant	32 (100%)	58 (72%)	p*	64 (100%)	98 (69%)	p*	39 (95%)	49 (40%)	p*
Concurrent chemotherapy
Docetaxel	11 (34%)	–		24 (38%)	–		8 (20%)	–
Carboplatin-vinorelbine	18 (56%)	–		27 (42%)	–		26 (63%)	–
Vinorelbine	1 (3%)	–		11 (17%)	–		7 (17%)	–
Carboplatin-etoposide	2 (6%)	–		2 (3%)	–		0 (0%)	–
Given dose
60 Gy	12 (38%)	64 (82%)		31 (48%)	103 (73%)		12 (29%)	56 (47%)
66 Gy	20 (63%)	14 (18%)	p*	33 (52%)	39 (28%)	p*	29 (41%)	64 (53%)	ns

*χ² testing the distribution of the variable separately in each age group. p*, p < 0.002, #: Including one patient PS = 3, ¤, Including one patient of 62 Gy, and one at 64 Gy. Some categories are missing data. CRT, chemo-radiation therapy; ns, not significant; y, year.

Table II. Univariate log rank analysis of the variables impact on overall survival in the total population.

Variable	p-Value
Age (continuous)	0.20
Concurrent chemotherapy	0.002
Gender (male vs. female)	0.07
PS (≥ 2 vs. < 2)	0.002
Body mass index (</≥ median value)	0.28
Smoking history (current smokers vs. non-smokers)	0.92
Prior cardiac event	0.30
Lung function (FEV1 </≥ 75% of normal value)	0.005
Histology (adenocarcinoma vs. other histology)	0.61
Stage (2B + 3A vs. 3B+ recurrent disease)	0.92
Year of RT (before or after 2006)	0.002
Neoadjuvant chemotherapy (yes/no)*	0.31
Given RT dose (60 Gy/higher)	0.58
Planning system (CADPLAN vs. Pinnacle)	0.21

*In the patients not receiving CRT.

Figure 1. Overall survival in patients with local-regional advanced NSCLC treated with radical radiotherapy with and without concurrent chemotherapy. Patient age A: < 60 year, B: 60–69 year, and C: ≥ 70 year.

Table III. Multivariate Cox proportional hazard regression in overall survival and lung cancer specific survival.

Overall survival	Hazard ratio (95% CI)	p-Value
Concomitant chemo-radiation (CRT+)	0.44 (0.20; 0.94)	0.034
Age*	1.02 (0.88; 1.19)	0.79
Interaction CRT × Age*	1.39 (1.01; 1.93)	0.050
Performance status (2–3)	1.53 (1.15; 2.03)	0.003
FEV1 (< 75% of normal)	1.27 (1.04; 1.55)	0.020
Treatment year (≥ 2006)	0.78 (0.61; 1.00)	0.046

Non-significant factor removed from the model: gender.
Lung cancer specific survival	Hazard ratio (95% CI)	p-Value
Concomitant chemo-radiation (CRT+)	0.44 (0.20; 0.96)	0.039
Age*	0.97 (0.83; 1.14)	0.74
Interaction CRT × Age*	1.41 (1.01; 1.98)	0.046
Performance status (2–3)	1.48 (1.09; 2.00)	0.011
FEV1 (< 75% of normal)	1.27 (1.04; 1.55)	0.020
Treatment year (≥ 2006)	0.80 (0.61; 1.03)	0.084

Non-significant factors removed from the model: gender.

*Units of the coding of age: 0, 1, 2 for < 60, 60–69, and ≥ 70 years, respectively.