Non-small-cell Lung Cancer : Retrospective Analysis at a Single Institution

Lung cancer is the most common among cause of cancer deaths in both men and women in world. NSCLC represent between 80% to 85% of all the diagnosed lung cancers cases (Boyle et al., 2005). At the time of diagnosis, In two-third of patients with lung cancer is diagnosed in locally advanced or metastatic disease. The median survival time for advanced disease is 5.8 to 12.6 months and the overall 5-year survival rate among this patient population is still less than 10% (Shepherd, 1993; Hotta et al., 2007). Systemic chemotherapy with the platinum-based doublets are still considered the first choice, which presents a modest survival advantage (Schiller et al., 2002; Azzoli et al., 2009). However, patients with advanced


Introduction
Lung cancer is the most common among cause of cancer deaths in both men and women in world. NSCLC represent between 80% to 85% of all the diagnosed lung cancers cases (Boyle et al., 2005). At the time of diagnosis, In two-third of patients with lung cancer is diagnosed in locally advanced or metastatic disease. The median survival time for advanced disease is 5.8 to 12.6 months and the overall 5-year survival rate among this patient population is still less than 10% (Shepherd, 1993;Hotta et al., 2007).
Systemic chemotherapy with the platinum-based doublets are still considered the first choice, which presents a modest survival advantage (Schiller et al., 2002;Azzoli et al., 2009). However, patients with advanced NSCLC eventually experience disease progression and require second-line therapy. For second-line therapy ASCO and NCCN guidelines suggest docetaxel, pemetrexed, or erlotinib (Azzoli et al., 2009). Second-line therapy provides the median survival time of 5-8 months in selected patients (Hanna et al., 2004;Ciuleanu et al., 2012).
is often to observe toxic side effects. While there are chemotherapy, very little knowledge is available about the prognostic factors in patients who receive secondbe concluded help that the choice of a treatment should be based according to prognostic factors.
The aim of this study was to investigate the prognostic factors for survival in patients with advanced NSCLC who patients receiving second-line treatments.

Materials and Methods
We retrospectively reviewed 107 patients receiving second-line treatments from August 2002 to March 2012 in the Dicle University, School of Medicine, Department of Medical Oncology.
They met the following inclusion criteria; 1) they had histologic or cytologic diagnosis of Stage IIIB or IV NSCLC; 2) they were 18 years or older in age; 3) receiving Evaluation Criteria in Solid Tumors (RECIST).
Fourteen potential prognostic variables were chosen on the basis of previously published clinical trials. The variables were divided to categories: age (<65 or  Adenocarcinoma was the most common histologic type between sex and tumour histology: adenocarcinoma was more common than squamous cell carsinoma among women (73.1% and 7.7%, respectively). Among patients receiving second-line therapy, median OS was 6 months and median PFS was 3 months. 23 patients (21.5%) received chemotherapy as a third -line therapy.
The results of univariate analysis for OS are summarized in Table 2. Among the fourteen variables of to second-line chemotherapy (p=0.006) and number of metastasis (p <0.001).
The results of univariate analysis for PFS are summarized in Table 3. Among the fourteen variables treatment. More interestingly, patients obtaining objective response during second-line treatment were shown to be an independent prognostic factor of PFS. However, Zietemann et al. (2011) found that response of second-line treatment had no impact on PFS, but response to previous chemotherapy had a predictive value with regard to PFS.
A poor PS is usually accepted a negative prognostic factor for all cancer patients (Mitry et al., 2004;Krishnan et al., 2006;Kim et al., 2008). The importance of PS was second-line treatment (Weiss et al., 2007;Wataya et al., 2009;Scartozzi et al., 2010;Maio et al., 2012). The current study demonstrated that PS not only negative affected OS, but also affected PFS negatively.
Many patients who maintain a poor PS and no tolerate line treatment. Life expectancy of patients with poor PS was substantially shorter than patients of a good PS. It remains ambiguous whether stage at diagnosis in patients receiving second-line treatment will ensure prognostic knowledge for survival. The previously by many authors (Weiss et al., 2007;Di Maio et al., 2010;Scartozzi et al., 2010) had shown that stage at diagnosis (2011) and Maio et al. (2012) no observed a prognostic value of stage. In our study, stage at diagnosis was identified to have prognostic significance for OS in univariate analysis, but the trend did not reach statistical hazard model. This result might be due to the small number of patients and difference of treatment choice The present study has got some limitations. Firstly, its retrospective study. Secondly, we did not evaluate molecular characteristics of the tumor. Thirdly, there was the small number of patients. factors for OS in advanced NSCLC patients who were undergoing second-line palliative treatment. Furthermore, PS and response to second-line chemotherapy were considered independent prognostic factors for PFS. It pretreatment prediction of survival and can be used for selecting patients for the correct choice of treatment. Therefore, prospective and larger clinical trials are needed. Di Maio M, Lama N, Morabito A, et al (2010 Fossella F, et al (2007). The impact of induction chemotherapy on the outcome of second-line therapy with pemetrexed or docetaxel in patients with advanced non-small-cell lung cancer. , 18, 453-60. Zietemann V, Duell T (2011). Prevalence and effectiveness of of unselected patients with advanced non-small cell lung cancer.