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P1.03 - Poster Session/ Treatment of Locoregional Disease – NSCLC (ID 212)
- Event: WCLC 2015
- Type: Poster
- Track: Treatment of Locoregional Disease – NSCLC
- Presentations: 1
- Coordinates: 9/07/2015, 09:30 - 17:00, Exhibit Hall (Hall B+C)
P1.03-030 - Marital Status Is Strongly Prognostic and Associated with More Favorable Nutritional Status in Locally Advanced Non-Small Cell Lung Cancer (ID 2390)
09:30 - 17:00 | Author(s): M. Vyfthius
We updated our previous analysis demonstrating marital status is prognostic in stage III NSCLC. We hypothesized that married patients have more favorable nutritional or immunologic status than unmarried patients as a potential mechanism for this survival advantage.
Between January 2000 and December 2010, 268 patients with stage III NSCLC received definitive chemotherapy and radiation therapy, with or without surgery at our institution. All had complete demographic, diagnosis, treatment, lab, and survival data. A Kaplan-Meier method estimated overall survival and we applied the log-rank test to compare mortality between groups. Multivariable analysis of prognostic factors was conducted using the Cox proportional hazards model. We tested the interaction between marital status and pre-treatment body mass index (BMI), albumin, white blood count, absolute neutrophil count, absolute lymphocyte count and calculated neutrophil-lymphocyte ratio (NLR).
More married patients presented with stage IIIA (rather than IIIB) disease (58% vs. 46%, P=0.03), had a PS 0 (57% vs. 36%, P<0.001), were white (69% vs. 43% (P<0.001) and lived in higher median income areas ($45,646 vs. $38,331, P<0.001) than non-married patients. There was no difference in tobacco history or diagnosis age between married and unmarried patients. After adjusting for stage, PS, race, and median household income, the hazard ratio for any-cause mortality in married patients was 0.59, 95% CI (0.45, 0.78), P<0.001. Median OS for married vs. unmarried patients was 28 (23, 34) vs. 16 (13, 19) months (P<0.001). Contrary to other reports, the reduction in mortality associated with being married was similar in males, 45%,and females 43%, with the test for interaction in a multivariable Cox model being non-significant (P=0.38). Figure 1 We also found married status was associated with higher median, 25[th], and 75[th] percentile BMI (26.3 vs. 23.8; 23.3 vs. 20.6, and 30.8 vs. 28.4, respectively; P=0.014) and albumin (3.7 vs. 3.6; 3.4 vs. 3.1; and 4.0 vs. 3.8, respectively; P=0.001).
Marital status is an important predictor of survival in stage III NSCLC and appears to offset the disadvantage of higher stage disease. Our results suggest one mechanism for this may be married patients have more favorable nutritional status evidenced by higher BMI and albumin. We did not find an association between marital status and immunologic status in our analysis. Future studies that evaluate how social support impacts nutritional status prior to therapy may lead to interventions to target vulnerable populations. Marital status may be an important stratification factor in clinical trials.