Prognostic value ​of Lung Cancer Subscale in older patients with advanced non-small cell lung cancer: An integrated analysis of JCOG0207 and JCOG0803/WJOG4307L (JCOG1414A)

Abstract

Objective: The Lung Cancer Subscale (LCS) of the Functional Assessment of Cancer Therapy-Lung (FACT-L) questionnaire is commonly used for evaluating lung cancer-specific symptoms. The objective of this study was to elucidate the prognostic value of the LCS in older patients with advanced non-small cell lung cancer (NSCLC).

Material and methods: We conducted an integrated analysis of data from two randomized phase III trials (JCOG0207, JCOG0803/WJOG4307L) including patients aged 70 years or older with advanced NSCLC to evaluate the prognostic value of LCS scores at baseline (Aim 1) and for symptom improvement (an increase in LCS of two points or more during treatment) (Aim 2). Multivariable analyses for survival, adjusted for baseline factors, were performed using a stratified Cox regression model with treatment regimen as a stratum.

Results: A total of 327 patients were included in the analysis for Aim 1 and 373 patients for Aim 2. Approximately 70% of patients were aged 75 or older. In Aim 1, use of descriptive statistics determined a cutoff point for baseline LCS score of 21. Multivariable analysis showed that higher baseline LCS was associated with favorable overall survival (OS) (hazard ratio [HR]: 0.68; 95% confidence interval [CI]: 0.52-0.89) and progression-free survival (HR: 0.68; 95% CI: 0.52-0.89). In Aim 2, symptom improvement was not associated with favorable OS (HR: 0.97; 95% CI: 0.72-1.23).

Conclusion: It is recommended to consider baseline LCS scores while determining treatment strategies for older patients with advanced NSCLC.

Keywords: Geriatric assessment; Health-related quality of life; Lung Cancer Subscale; Non-small cell lung cancer; Prognostic value.