Hoang et al developed a model to predict survival in patients with advanced non-small cell lung carcinoma treated with a third generation chemotherapeutic regimen. The model is based on pretreatment variables and can help decide if more aggressive or novel therapy may be needed. The authors are from the University of Wisconsin, Dana-Farber Cancer Center, Rush Presbyterian St. Luke's Medical Center (Chicago) and Vanderbilt University.
Patient selection:
(1) lung carcinoma other than small cell carcinoma
(2) Stage IIIB with malignant pleural effusion or Stage IV (metastatic)
(3) ECOG performance scale 0 to 2
(4) chemotherapy naive
Chemotherapy regimens: platinum-based doublets (involve either paclitaxel, docetaxel or gemcitabine)
Parameters:
(1) previous lung surgery
(2) ECOG performance scale
(3) loss of appetite
(4) skin metastasis
(5) liver metastases
(6) total number of metastatic sites (multiple metastatic foci to one organ would be counted as 1)
|
Parameter
|
Finding
|
Points
|
|
previous lung surgery
|
no
|
15
|
|
|
yes
|
0
|
|
ECOG performance scale
|
0
|
0
|
|
|
1 or 2
|
43
|
|
loss of appetite
|
no
|
0
|
|
|
yes
|
38
|
|
skin metastasis
|
no
|
0
|
|
|
yes
|
66
|
|
liver metastasis
|
no
|
0
|
|
|
yes
|
35
|
|
total number of metastases
|
0 to 3
|
0
|
|
|
>= 4
|
19
|
total score =
= SUM(points for all 6 parameters)
Interpretation:
• minimum score: 0
• maximum score: 216
• The higher the score the lower the probability of 1 and 2 year survival.
• The probability of 1 and 2 year survival are read off a nomogram shown in Figure 1, page 179.
If the 1 year survival nomogram is analyzed in JMP:
probability of 1 year survival with points from 0 to 140.2 points =
= (-0.340892 * (points)) + 55.35959
probability of 1 year survival with points from 140.2 to 216 points =
= (0.001139 * ((points)^2)) - (0.515165 * (points)) + 58.8069
If the 2 year survival nomogram is analyzed in JMP over range of 0 to 160 points (above 160 points the chance of survival is a fraction of 1%):
probability of 2 year survival with points from 0 to 81.1 points =
= (0.001168 * ((points)^2)) - (0.38367 * (points)) + 29.2486
probability of 2 year survival with points from 81.1 to 160 points =
= (0.000965 * ((points)^2)) - (0.3053 * (points)) + 24.3688
