Prognostic Factors of Chinese Non-small Cell Lung Cancer Patients Receiving Best Supportive Care

This study aims to identify prognostic factors for Chinese patients with non-small cell lung cancer (NSCLC) receiving best supportive care (BSC) alone.

This retrospective study investigated patients with newly diagnosed NSCLC who underwent staging fluorodeoxyglucose (FDG) positron emission tomography (PET) and CT at Queen Elizabeth Hospital between 1st January 2018 and 31st March 2024, and were managed exclusively with BSC, without surgery, radiotherapy, or systemic therapy. The inclusion criteria were the following: 1) histologically proven NSCLC, 2) Chinese ethnicity receiving BSC alone, and 3) regular clinical follow-up till death. Subjects were excluded if they had 1) a history of lung neoplasm, 2) a concurrent active neoplasm, 3) defaulted follow-up, or 4) life-threatening events at the first oncology consultation. Potential prognostic determinants were evaluated, including age, gender, performance status, comorbidities, smoking history, previous malignancy, lung tumor histology, serum tumor marker, maximum diameter, as well as maximum standardized uptake value (SUVmax) of the primary tumor, number of metastatic organs, and the presence of pleural/pericardial effusion. Univariate log-rank tests and multivariate Cox proportional hazards regression were performed. The rationale for BSC and the eventual causes of death were analyzed.

Univariate analysis identified male gender, poorer performance status, histology of NSCLC not otherwise specified, larger primary tumor, greater primary tumor SUVmax (higher FDG uptake in primary tumor), and the presence of pleural or pericardial effusion as negative prognostic factors. Subsequent multivariate Cox regression showed four factors retained independent statistical significance: gender, performance status, maximum tumor diameter, and the presence of pleural/pericardial effusion. Three major concerns for the patient's decision to opt for best supportive care were concerns regarding treatment side effects (32.1%), advanced age (25.9%), and poor performance status (17.3%).

This study shows that gender, performance status, tumor diameter, and presence of pleural/pericardial effusion are significant prognostic factors of overall survival in NSCLC patients receiving BSC exclusively.