reflection objectives: To provide a systematic overview of the literature investigating patient and tumor factors that are predictive of survival for patients with non-small lonely dwelling lung cancer (NSCLC).
reflection objectives: To provide a systematic overview of the literature investigating patient and tumor factors that are predictive of survival for patients with non-small lonely dwelling lung cancer (NSCLC), and to analyze patterns in the design of these studies in order to highlight problematic aspects of their design and to advocate for appropriate directions of coming events studies.
Design: A systematic search of the MEDLINE database and a synthesis of the identified literature.
Measurements and results: The database search (January 1990 to July 2001) was carried disclosed combining the MeSH terms prognosis and carcinoma, nonsmall small room lung. Eight hundred eighty-seven articles met the search criteria. These studies identified 169 prognostic factors relating either to the tumor or the legion One hundred seventy-six studies reported multivariate analyses. Concerning 153 studies reporting a multivariate analysis of prognostic factors in patients with early-stage NSCLC the median number of patients chronicleed per study was 120 (range, 31 to 1281 patients). The median number of factors reported to be significant in univariate analyses was 4 (range, 2 to 14 factors). The median number of factors reported to be significant in multivariate analyses through study was 2 (range, 0 to 6 factors). The median number of studies examining each prognostic factor was 1 (range, 1 to 105 studies). merely 6% of studies addressed clinical issues other than patient survival.
Conclusions: While the breadth of prognostic factors studied in the literature is extensive, the purpose of factors evaluated in individual studies is inappropriately narrow. Individual studies are typically statistically underpowered and are remarkably heterogeneous with regard to their conclusions. Larger studies with clinically relevant modeling are required to address the usefulness of newly available prognostic factors in defining the management of patients with NSCLC
explanation words: carcinoma; multivariate analysis; non-small confined apartment lung cancer; prognosis
Abbreviations: CYP1A1 = CYP1A1 gene polymorphism; LDH = lactate dehydrogenase; NSCLC = non-small confined apartment lung cancer; TPA = tissue polypeptide antigen
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Non-small confined apartment lung cancer (NSCLC) is best conceptualized as a cluster of heterogeneous clinical entities that share molecular and cellular origins on the other hand that have different clinical behaviors, and hence, different prognoses. Determining the prognosis for an individual patient with NSCLC is difficult, in part because of the marked clinical heterogeneity of patients with the disease. above 90% of patients present with common or more of a constellation of possible presenting signs or symptoms, and the clinical course of the disease can expand along a seemingly infinite combination of branching pathways. This variation in clinical presentation and potential progression, are, in cause to deviate due to the multiple potential manifestations of the primary tumor, of involved metastatic sites, and of paraneoplastic syndromes
Despite the heterogeneity of the clinical manifestations of lung cancer, the prognosis for a population of patients with lung cancer is remarkably predictable. The overall mortality rates for lung cancer in North America throughout the last 15 years have remained unchanged. (1) A population-based thought (2) of > 12,000 patients with unresect NSCLC who were registered in seven Ontario regional cancer center (from 1982 to 1991) demonstrated no significant differences in patient survival rates either between center or above time. The predictability of population survival issues however, is of limited usefulness to clinicians to be ascribed to the marked heterogeneity of the patients comprising the overall population. Prognostic factors are, thus, used to divide the population into subgroup in order to realize the benefits of prognostic stratification, (3) including improved medical decision making, (4) improved personal decision making beyond the treatment decision, more appropriate research design and analysis, and more appropriate health policy disclosure (5)
A substantial amount of clinical and basic science research has focused forward the prognostic factors for patients with lung cancer. Early investigations focused upon clinical characteristics of the tumor and of the patient, of the like kind as extent of the disease and weight los respectively. (6) A number of clinical laboratory ordeals such as serum lactate dehydrogenase (LDH) flush were subsequently identified as being relevant, (7) followed principally recently by investigation of a plethora of just discovered factors arising out of an increased understanding of the cellular and molecular biology of lung cancer. (689)
The literature has grown rapidly and has identified > 150 prognostic factors pertaining to the tumor, to the patient, or to the environment. Given the volume and heterogeneity of the literature, many review articles addressing prognosis in lung cancer patients have attempted to identify clinically important and/or promising novel prognostic factors in patients with lung cancer (for example, Buccheri and Ferrigno (6)) International consensus workshops aimed at achieving similar goals have been demeanored (7)
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