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Vol. 37. Issue 11.
Pages 477-481 (November 2001)
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Vol. 37. Issue 11.
Pages 477-481 (November 2001)
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Carcinoma broncogénico no microcítico en estadios avanzados: influencia pronóstica de la pérdida de peso e implicaciones clínicas
Non-small cell bronchogenic carcinoma in advan-ced stages: prognostic value of weight loss and clinical implications
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J.A. Gullón
, R. Fernández, G. Rubinos, A. Medina, I. Suárez, I.J. González
Sección de Neumología. Hospital Universitario de Canarias. La Laguna. Santa Cruz de Tenerife
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Objetivos

Se diseñó un estudio en carcinoma broncogé-nico no microcítico en estadios avanzados, con los siguientes objetivos: a) identificar factores pronósticos recogidos en el momento del diagnóstico, y b) precisar si la pérdida de peso es un parámetro útil para seleccionar a los sujetos que ob-tendrían un mayor beneficio del tratamiento oncológico

Pacientes Métodos

Se incluyó a 81 pacientes diagnostica-dos de carcinoma broncogénico no microcítico en estadios III-b y IV y con grado de actividad menor de 2 según ECOG. Las variables a estudiar fueron: edad, sexo, antecedentes de tabaquismo, comorbilidad, datos clínicos (pérdida de peso, disnea, síndrome de vena cava superior), parámetros de la-boratorio (hemoglobina, albúmina sérica, linfocitos totales, lactatodeshidrogenasa sérica, calcemia y enzimas hepáticas), tipo histológico, grado de actividad, estadificación tumoral (TNM), tratamiento recibido y supervivencia en semanas

Se analizaron dos grupos: grupo general, formado por to-dos los pacientes, y grupo sin pérdida de peso, constituido por los sujetos en que estaba ausente este síntoma

Para el estudio estadístico y de supervivencia se utilizaron las siguientes pruebas: t de Student, χ2, Kaplan-Meier, test de rangos logarítmos y modelos de regresión de Cox

Resultados

La mediana de supervivencia fue de 29 se-manas (rango: 21–37). En el grupo general presentaban un relación significativa con la supervivencia los siguientes pa-rámetros: pérdida de peso, linfocitos totales, LDH sérica, TNM y grado de actividad. De éstos, sólo mantenían impli-cación pronóstica en el estudio multivariado de pérdida de peso (HR: 1,48 [1,14-1,92]; p=0,002) y la TNM (HR: 0,72 [0,54-0,96]; p=0,02)

En el grupo sin pérdida de peso en el univariado tienen relación significativa el tratamiento recibido y la TNM, con-servando ambas una correlación con el pronóstico al incluir-las en modelos de regresión de Cox

Conclusiones

En nuestra experiencia, en carcinoma de pulmón en estadios avanzados subsidiarios de tratamiento oncológico, la pérdida de peso es la variable con mayor po-der pronóstico, por lo que podría ser conveniente conside-rarla de manera rutinaria, conjuntamente con el grado de actividad, para intentar identificar a los pacientes que ob-tendrían un mayor beneficio del tratamiento citostático

Palabras clave:
Factores pronósticos
Carcinoma broncogénico

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 re-ceive greater benefit from anticancer therapy

Patients and methods

Eighty-one patients were enrolled af-ter diagnosis of stage III-B and IV non-small cell broncho-genic carcinoma and levels of activity < 2 according to Eas-tern 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

Results

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 multivaria-te 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 univaria-ble analysis and in Cox's regression model

Conclusions

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 be-nefit from cytostatic treatment

Keywords:
Prognostic factors
Bronchogenic carcinoma
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Copyright © 2001. Sociedad Española de Neumología y Cirugía Torácica
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