Souhami et al identified clinical and laboratory parameters at the time of diagnosis of a small cell carcinoma of the lung that are prognostic for the patient. These can help identify patients who may benefit from more aggressive or novel therapies. The authors are from University College Hospital, London Chest Hospital, Guy's Hospital and Brompton Hospital in London.
Patient selection: newly diagnosed small cell carcinoma of the lung
Parameters:
(1) Karnofsky performance scale (KPS)
(2) serum albumin
(3) serum sodium
(4) serum alkaline phosphatase
Criteria for Category 1 (good prognosis) - all of the following:
(1) Karnofsky performance scale > 70
(2) albumin > 3.9 g/dL
(3) serum sodium > 136 mmol/L
(4) serum alkaline phosphatase < 1.5 times the upper limit of normal
Criteria for Category 3 (poor prognosis) - one of the following:
(1) serum alkaline phosphatase > 3 times the upper limit of normal, OR
(2) Karnofsky performance scale < 40, OR
(3) serum albumin < 3.8 g/dL AND serum sodium < 135 mmol/L
Criteria for Category 2 (intermediate prognosis) - not Category 1 or 3.
|
Prognostic Group
|
50% Survival
|
Probability of 2 Year Survival
|
|
good
|
11 months
|
15%
|
|
intermediate
|
7.5 months
|
5%
|
|
poor
|
4.5 months
|
1 -2%
|
For each group limited disease (confined to one hemithorax and ipsilateral supraclavicular lymph nodes) had a better prognosis than extensive disease.
Vincent et al (page 1595) developed a modified version of the Souhami model in the analysis of their data:
Good Prognosis - all of the following:
(1) ECOG performance scale 0 or 1
(2) serum albumin >= 3.6 g/dL
(3) serum sodium > 136 mmol/L
(4) serum alkaline phosphatase < 1.5 times the upper limit of normal
Poor Prognosis - one of the following:
(1) serum alkaline phosphatase > 3 times the upper limit of normal
(2) ECOG performance scale 3 or 4
(3) serum albumin < 3.6 g/dL AND serum sodium < 135 mmol/L
