'Tumour volume' as a predictor of survival after resection of non-small-cell lung cancer (NSCLC)

Many factors have been individually related to outcome in populations of non-small-cell lung cancer (NSCLC) patients. Factors responsible for the outcome of an individual after surgical resection are poorly understood. We have examined the importance of 'tumour volume' in determining prognosis of patients following resection of NSCLC in a multivariate model. Cox's proportional hazard analysis was used to determine the relative prognostic significance of stage, patient age, gender, tumour cell-type, nodal score and estimated 'tumour volume' in 669 cases with NSCLC treated with surgical resection, of which 280 had died. All factors (except tumour cell-type, P=0.33) were individually related to survival (P<0.05). When examined together, survival time was significantly and independently related to 'tumour volume' and stage (P<0.001), and other factors ceased to be significant. In cases with stage I or II rumours, risk of death was found to increase significantly with increasing estimated 'tumour volume' (23.8% relative increase in hazard of death per doubling of 'tumour volume', 95% confidence interval 13.2-35.2%, P<0.001 stage I; P<0.006 stage II). In cases with stage IIIa tumours this factor alone was the significant prognostic variable. In conclusion, an estimate of 'tumour volume' significantly improves prediction of prognosis for individual NSCLC patients with UICC stage I or II tumours.