Lama Sakr1, David Small2, Goulnar Kasymjanova3, Samy Suissa4, Pierre Ernst5. 1. Division of Pulmonary Diseases, Department of Medicine, Jewish General Hospital, McGill University, Quebec, Canada. Electronic address: lama.sakr@mail.mcgill.ca. 2. Division of Pulmonary Diseases, Department of Medicine, Jewish General Hospital, McGill University, Quebec, Canada. 3. Peter Brojde Lung Cancer Centre, Jewish General Hospital, Montreal, Quebec, Canada. 4. Department of Epidemiology and Biostatistics, McGill University, Quebec, Canada; Center for Clinical Epidemiology, Lady Davis Institute, Jewish General Hospital, McGill University, Montreal, Quebec, Canada. 5. Division of Pulmonary Diseases, Department of Medicine, Jewish General Hospital, McGill University, Quebec, Canada; Department of Epidemiology and Biostatistics, McGill University, Quebec, Canada; Center for Clinical Epidemiology, Lady Davis Institute, Jewish General Hospital, McGill University, Montreal, Quebec, Canada.
Abstract
INTRODUCTION: Significant differences in outcome are observed among lung cancer patients belonging to the same tumor node metastasis stage, suggesting phenotypic heterogeneity beyond this staging algorithm. We used a cluster analysis approach to classify patients into distinct phenotypes, and we attempted to validate the clinical relevance of these phenotypes by comparing outcome. METHODS: We formed a cohort of all stage I to III non-small-cell lung cancer patients seen between January 2004 and October 2010 in a cancer center and followed until death or last follow-up appointment, with prospectively collected data on clinical and tumor characteristics. Multiple correspondence analysis was followed by hierarchical clustering to form homogenous clusters of patients. Overall survival and disease-free survival estimates were compared among clusters. RESULTS: The cohort included 367 patients (mean follow-up of 2.5 years), 173 of whom died during that period (191 deaths per 1000 person-years). A four-cluster model was identified, revealing distinct phenotypes with respect to baseline characteristics. Hazard ratios for mortality were 8.1, 5.0, and 3.7 (all statistically significant) for clusters 2, 1, and 3, respectively, when compared with cluster 4-with the most favorable outcome. CONCLUSION: Staging of patients with non-small-cell lung cancer for prognostic purposes may be improved by considering phenotypes that exhibit significant differences in clinical course and outcome.
INTRODUCTION: Significant differences in outcome are observed among lung cancerpatients belonging to the same tumor node metastasis stage, suggesting phenotypic heterogeneity beyond this staging algorithm. We used a cluster analysis approach to classify patients into distinct phenotypes, and we attempted to validate the clinical relevance of these phenotypes by comparing outcome. METHODS: We formed a cohort of all stage I to III non-small-cell lung cancerpatients seen between January 2004 and October 2010 in a cancer center and followed until death or last follow-up appointment, with prospectively collected data on clinical and tumor characteristics. Multiple correspondence analysis was followed by hierarchical clustering to form homogenous clusters of patients. Overall survival and disease-free survival estimates were compared among clusters. RESULTS: The cohort included 367 patients (mean follow-up of 2.5 years), 173 of whom died during that period (191 deaths per 1000 person-years). A four-cluster model was identified, revealing distinct phenotypes with respect to baseline characteristics. Hazard ratios for mortality were 8.1, 5.0, and 3.7 (all statistically significant) for clusters 2, 1, and 3, respectively, when compared with cluster 4-with the most favorable outcome. CONCLUSION: Staging of patients with non-small-cell lung cancer for prognostic purposes may be improved by considering phenotypes that exhibit significant differences in clinical course and outcome.
Authors: Zihe Zheng; Sushrut S Waikar; Insa M Schmidt; J Richard Landis; Chi-Yuan Hsu; Tariq Shafi; Harold I Feldman; Amanda H Anderson; Francis P Wilson; Jing Chen; Hernan Rincon-Choles; Ana C Ricardo; Georges Saab; Tamara Isakova; Radhakrishna Kallem; Jeffrey C Fink; Panduranga S Rao; Dawei Xie; Wei Yang Journal: J Am Soc Nephrol Date: 2021-01-18 Impact factor: 14.978