[Non-small cell bronchogenic carcinoma in advanced stages: prognostic value of weight loss and clinical implications]

This study of advanced-stage non-small cell bronchogenic carcinoma aimed 1) to identify prognostic factors collected at the moment of diagnosis, 2) to determine whether weight loss is a useful parameter to screen for subjects who will receive greater benefit from anticancer therapy.Patients and methods. Eighty-one patients were enrolled after diagnosis of stage III-B and IV non-small cell bronchogenic carcinoma and levels of activity < 2 according to Eastern Co-operative Oncology Group classification. The variables studied were age, sex, smoking history, associated disease, clinical data (weight loss, dyspnea, superior vena cava syndrome), laboratory parameters [hemoglobin, serum albumin, total lymphocytes, serum lactate dehydrogenase (LDH), calcium and liver enzymes], tumor-node-metastasis (TNM) staging, histologic type, activity, treatment received and survival in weeks. The results were analyzed in two groups: 1) the general group consisting of results for all patients, and 2) the no-weight-loss group consisting of results for those whose weight had been stable. Student t, chi-squared, Kaplan Meier, log-rank and Cox's regression model were used to analyze data and survival.

Mean survival was 29 weeks (21-37). Survival was significantly related to weight loss, total lymphocytes, serum LDH, TNM and activity level in the general group. Only two factors continued to have prognostic value in the multivariate study: weight loss (OR: 1.48 (1.14-1.92), p = 0.002) and TNM (OR: 0.72 (0.54-0.96), p = 0.02). Among the patients with no weight loss, treatment received and TNM were significantly related to survival in univariable analysis and in Cox's regression model.

In our experience with advanced lung cancer subjected to anticancer therapy, the presence of weight loss is the variable with the greatest prognostic value, such that it may be useful to consider it routinely, along with activity level, to try to identify patients who will receive the most benefit from cytostatic treatment.