This study investigated the factors associated with long-term survival (>2 years) of patients with advanced non-small cell lung cancer. New factors, including administration of maintenance therapy, surgery, time to first progression of the tumour and a performance status of 0-1 at first progression were significant factors.

Background and objective: Only a small proportion of patients with advanced non-small cell lung cancer (NSCLC) have a life expectancy greater than two years. The aim of this study was to identify the factors associated with long-term survival of patients with advanced NSCLC.

Methods: Patients who had received chemotherapy for stage IIIb or IV NSCLC that was not amenable to radiotherapy, were studied retrospectively. Data was gathered prospectively from a comprehensive database. Long-term survivors (>2 years) were compared with the other patients, with respect to clinical, biological and tumour-node-metastasis (TNM) criteria.

Results: Data for 245 consecutive patients was collected. Thirty nine patients (15.9%) survived for more than two years. Long-term survivors were more likely to have had metastases at fewer sites (P= 0.008), an absence of bone metastases (P= 0.01), a performance status (PS) of 0-1 at first progression of the tumour (P= 0.002), a tumour that was controlled with first (P < 0.0001) and second line (P= 0.004) chemotherapy, maintenance therapy (P= 0.001), curative surgery (P < 0.0001), time to first progression of the tumour of >3 months (P < 0.0001), normal LDH levels at diagnosis (P= 0.049), and a haemoglobin concentration >110 g/L at first progression of the tumour (P= 0.02). In multivariate analysis, surgery, maintenance treatment, time to first progression of the tumour of >3 months, a PS of 0-1 at first progression, the number of chemotherapy agents received, and LDH levels, were significant predictors of long-term survival.

Conclusions: Assessment of these factors, and the use of maintenance therapy, when possible, may identify a population of patients with NSCLC that is likely to have a prolonged life expectancy.