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The Effect of Alcoholism on the Prognosis of Stage III and IV Non-small Cell Lung Cancer

Dayton VA Medical Center, Wright State Univ. School of Medice, Dayton, OH

PURPOSE: The purpose of this study was to determine the effect of alcoholism on survival among patients with stage III and IV non-small cell lung cancer (NSCLC).

METHODS: The records of 74 consecutive patients with clinicopathologic stage III/IV NSCLC receiving treatment at a VA Medical Center were analyzed. Twenty four alcoholic (Etoh) patients [defined by a DSM-IV diagnosis of dependence (303.90), abuse (305.00), or an alcohol consumption of > 60 ounces of alcohol per day] were compared to 50 non-alcoholic (Non-etoh) patients.

RESULTS: Overall survival was worse in the Etoh group compared to the Non-etoh group, 9.5 ± 2.0 vs. 13.8 ± 1.8 months, respectively, p<0.05. Progression free survival was 7.0 ± 1.6 and 12.5 ± 1.9 months for Etoh and Non-etoh patients, respectively, p=0.02, Figure 1 . Survival differences were not explained by discrepancies in Eastern Cooperative Oncology Group (ECOG) performance status, stage of disease, Charlson comorbidity index, smoking history, pulmonary function, liver enzymes, or nutritional parameters. Alcoholics were more likely to refuse treatment, less likely to receive multimodality treatment, received a lower total dose of radiation, and were less likely to respond to chemotherapy than non-alcoholic patients. Toxicity of chemotherapy was similar between Etoh and Non-etoh groups, Table 1
Table 1. Clinical data in patients with stage III and IV non-small cell lung cancer (NSCLC). Alcoholic (Etoh) vs. Non-alcoholic (Non-etoh).

Etoh Non-etoh P value Alcohol consumption (ounces/day) 137 ± 23 26 ± 3.7 0.0041 Divorce, jobless, homeless 16 / 24 9 / 50 0.00012 Stage of disease (III/IV) 16 / 8 30 / 20 NS2 ECOG3 performance 0.9 ± 0.1 1.2 ± 0.1 NS1 Charlson comorbidity 2.2 ± 0.3 2.2 ± 0.2 NS1 Pack years smoking 68 ± 6.9 60 ± 4.0 NS1 Bilirubin (mg/dl) 0.6 ± 0.04 0.6 ± 0.03 NS1 Albumin (g/dl) 3.8 ± 0.1 3.9 ± 0.1 NS1 Paclitaxel4 total dose (mg/M2) 456 ± 101 509 ± 59 NS1 Carboplatin4 total dose (mg/M2) 1128 ± 209 926 ± 113 NS1 Grade 2-44,5 Granulocytopenia 6 / 13 8 / 29 NS2 Stage III patients refusing treatment6 7 / 16 1 / 30 0.0012 Stage III patients receiving multimodality treatment6 8 / 16 24 / 30 0.052 Total radiation dose to primary tumor (cGy) in patients receiving radiation7 4145 ± 611 5468 ± 238 0.038 Response to chemotherapy stage III/IV patients4 3 / 13 17 / 29 0.052

¹ Two tailed unpaired student t test, p< 0.05 significant, NS=non-significant.

² Two tailed Fisher exact test, p<0.05 significant, NS=non-significant.

³ Eastern Cooperative Oncology Group

⁴ 13 Etoh and 29 Non-etoh patients with stage III and IV NSCLC receiving chemotherapy.

⁵ NCI Common Terminology Criteria for Adverse Events v. 3.0, Dec. 12, 2003.

⁶ 16 Etoh and 30 Non-etoh patients with stage III NSCLC.

⁷ 12 Etoh and 35 Non-etoh patients receiving radiation for stage IIIand IV NSCLC.

⁸ Mann Whitney U test.

. Alcohol abuse (B=0.59, p=0.03, hazard ratio=1.82) and ECOG status (B=0.57, p=0.02, hazard ratio=1.77) were the two best predictors of survival in a Cox proportionate hazards model. In multiple logistic regression, alcohol abuse predicted lack of response to chemotherapy (B=2.9, p=0.03, Odds ratio=18.3).

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CLINICAL IMPLICATIONS: Given the high prevalence of both alcohol abuse and lung cancer in the VA population, the results of this study, if confirmed, may have important prognostic and therapeutic implications.

DISCLOSURE: D.E. Paull, None.