Memorial Sloan Kettering Cancer Center MSKCC experience

The series concerned 161 patients with stage IIB, IIIB, or IV disease who were treated between 1975 and 1984 according to two successive protocols.21 All patients received combined-modality therapy. The main end point was overall survival. With multivariate analysis, five factors were shown to have independent prognostic value: age >45 years, serum LDH > 400 UI/L, low (abnormal) hematocrit, inguinal involvement, and bulky mediastinal mass >0.45 of the thoracic aperture. Since the regression coefficients corresponding to the five factors were of the same magnitude (range 1.49-2.99), each of them was considered with equal significance. Therefore, the prognostic score was derived from the sum of adverse factors present, theoretically ranging 0-5. Patients who expressed none or only one adverse factor (60% of all patients) were considered at low risk of death, while those with two or more (40% of patients) were considered at high risk of death. The same five factors plus one, bone marrow involvement, were used to predict for disease progression. Again, patients who expressed none or only one adverse factor displayed significantly better progres sion-free survival rate at 4 years than those who expressed two or more factors.

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