There is limited data from developing countries on comorbidity (CO-M) assessment in LC. This prospective study assessed prevalence and association of CCI and SCS with clinical outcomes in a cohort of newly diagnosed LC patients undergoing chemotherapy (CTx) between Jan 2012 - March 2013 at a tertiary care centre in North India.
Variables assessed included age, gender, smoking status, performance status (PS), stage, histology and CO-M. All patients received histology guided standard platinum based doublet CTx. Clinical outcomes assessed were overall survival (OS), radiological responses (RRs) by RECIST and toxicity by CTC v3.0. Correlations of CCI and SCS were assessed by Spearman's (Rho) method. Median OS was obtained by Kaplan Meir method, group differences analyzed by log rank test and uni/multivariate analysis by Cox Proportional Hazard (CPH) modeling.
Majority of 238 LC pts were males (85.3%), current/ex-smokers (83.6%) and had advanced disease (IIIB 33.6%; IV 42.4%). Distribution of histology was 39.9% SqCC, 32.8% ADC, 19.7% SCLC and of PS was 63% ECOG 0-1, 30.7% ECOG 2. CO-M distribution was 173 SCS ≤ 9; 65 SCS > 9 and 88 CCI = 0; 97 CCI = 1; 53 CCI ≥ 2. Median (IQR) was SCS = 7 (7-11) and CCI = 1 (0-1). Correlation between CCI and SCS was moderate (Rho = 0.474; p < 0.001). Age correlated weakly with both SCS (Rho = 0.293; p < 0.001) and CCI (Rho = 0.205; p < 0.001). SCS > 9 group (vs. SCS ≤ 9) had significantly higher mean age 62.4 yrs (vs. 56.5), greater % of pts ≥70 yrs (24.6% vs. 10.4%), males, smokers and SqCC. Mean age 55.2 yrs CCI = 0, 59.6 yrs CCI = 1 and 60.3 yrs CCI = 2 differed significantly; p = 0.002. RRs and toxicity profiles were similar between SCS ≤ 9 & SCS > 9 and also between CCI = 0, CCI = 1 and CCI ≥ 2. Median OS was 287 days (95% CI = 232-342) and did not differ between SCS & CCI based groups. On multivariate CPH analysis, worse OS was independently associated with stage IV disease [HR = 2.0 (95% CI = 1.4-2.7)] and poor PS (ECOG ≥ 2) [HR = 1.8 (95% CI = 1.1-2.8)] but not with CO-M, histology or age.
SCS and CCI scores correlated moderately with each other and weakly with age. CO-M did not adversely influence clinical outcomes in this Indian cohort of LC pts undergoing CTx.
Clinical trial identification
All authors have declared no conflicts of interest.