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.

Purpose. Significant advances in the systemic management of metastatic non-small cell lung cancer (NSCLC) have occurred over the past decade, with options now including multiple lines of chemotherapy, epidermal growth factor receptor inhibitors, and antiangiogenic agents. Improvements in overall survival have been demonstrated in randomized controlled trials comparing these newer agents with best supportive care or standard therapy. This study examined uptake of these therapies in general practice and their impact on survival.

Methods. This retrospective cohort study compared demographic, treatment, and survival data among 987 patients diagnosed with stage IV NSCLC at two institutions in 1998, 2003, and 2008. Cohorts were selected based on intervals when doublet chemotherapy, second-line chemotherapy, and targeted agents were incorporated into the standard treatment regimen.

Results. The proportion of patients receiving systemic therapy increased over time (20% in 1998, 42% in 2008). Overall survival improved significantly across cohorts (p < .001), with 2-year survival rates of 0.3% in 1998, 4% in 2003, and 15% in 2008. In a multivariate survival analysis, the 2003 and 2008 cohorts were independently associated with longer survival, as was the use of one or more lines of systemic therapy. Elderly patients (aged ≥70 years) were also more likely to receive systemic therapy over time, with longer overall survival (p < .001).

Conclusion. Over the past decade, there has been an increasing use of systemic therapy in stage IV NSCLC patients, including the elderly. This has been associated with significantly longer overall survival.