Prognostic Factors of Chinese Non-Small Cell Lung Cancer Patients with Best Supportive Care

Background/Objectives: To identify the potential prognostic factors of overall survival in Chinese patients with non-small cell lung cancer (NSCLC) who opted for best supportive care (BSC) alone. Methods: This retrospective study investigated the patients with newly diagnosed NSCLC who underwent staging FDG PET/CT at Queen Elizabeth Hospital between 1st Jan 2018 and 31st Mar 2024, then managed with BSC exclusively without surgery, radiotherapy or systemic therapy. The subjects had regular follow-up from oncologists and/or palliative medicine physicians until death. Potential prognostic determinants of overall survival were evaluated, including age, gender, performance status, co-morbidities, smoking history, previous malignancy, lung tumor histology, serum tumor marker (carcinoembryonic antigen), maximum tumor diameter as well as maximum Standardized Uptake Value (SUVmax) of the primary tumor, number of metastatic organs, and the presence of pleural or pericardial effusion. For statistical evaluation, univariate log-rank tests and multivariate Cox proportional hazards regression were performed to identify independent prognostic factors. The rationale for BSC and the eventual causes of death were also analyzed. Results: Univariate analysis identified male gender, poorer performance status, histology of NSCLC not otherwise specified, larger primary tumor, greater tumor SUVmax and the presence of pleural or pericardial effusion as negative prognostic factors. Subsequent multivariate Cox regression showed four factors retained independent statistical significance: gender, performance status, maximum tumor diameter and the presence of pleural/pericardial effusion. The three major rationales of the patients pursuing BSC were concerns regarding treatment side-effect (32.1%), advanced age (25.9%) and poor performance status (17.3%). The most common cause of death was pneumonia (76.7%). Conclusions: This study shows that gender, performance status, tumor diameter and presence of pleural/pericardial effusion are significant prognostic factors of overall survival in NSCLC patients receiving BSC exclusively.