Accurate prognostic information for advanced NSCLC enables doctors and patients to make appropriate treatment decisions and plans for the future. Traditional prognostic factors including performance status (PS) and stage provide broad survival estimates, but further refinement is required. We sought to determine the prognostic significance of routinely measured blood tests for patients with metastatic NSCLC.
We retrospectively reviewed electronic medical records for patients at Liverpool and Macarthur Cancer Therapy Centres diagnosed with metastatic NSCLC between 2008 and 2012. For each patient we extracted demographics, tumour characteristics and survival from date of diagnosis of metastatic disease. We defined baseline blood tests as the first test collected within 2 weeks of diagnosis and used local health district parameters to define normal values. Associations between survival and haemoglobin, white cell count, neutrophils, lymphocytes and albumin were determined using multivariable Cox proportional hazards models.
We identified 353 patients with a median age of 67 years (range 31-94). 64% were male, 88% had a smoking history, 46% had adenocarcinoma histology and 62% were ECOG PS ≤ 2. The median overall survival (OS) was 5.7 months (interquartile range 2.3 months – 11.8 months). Baseline factors independently associated with shorter OS were ECOG PS >2 (HR 2.76; 95% CI 2.1-3.6; p < 0.01); white cell count ≥ 11 x 109/L (HR 1.49; 95% CI 1.1-1.9; p < 0.01); albumin ≤ 38 g/L (HR 1.41; 95% CI 1.1-1.8; p < 0.01) and Asian birthplace (HR 1.65; 95% CI 1.1-2.5; p < 0.01).
Our results confirm that leucocytosis and hypolbuminaemia are independently significant for prognosis and may be useful to consider along with ECOG PS when estimating survival for patients with stage IV NSCLC.