Deterioration of performance status before administration of chemotherapy as a prognostic factor in untreated advanced non-small cell lung cancer

Introduction: The prognostic impact of changes in performance status (PS) of untreated patients with advanced non-small cell lung cancer (NSCLC) are not clear. This study aimed to evaluate the prognostic impact of acute PS deterioration in patients with untreated advanced NSCLC. Methods: This study is a single center, retrospective, observational study. Patients with Stage IV NSCLC who were referred to our institution between January 2018 and March 2023 were retrospectively reviewed. Patients were divided into three groups: 1) patients with PS 0 or 1 at referral and the start of chemotherapy; 2) patients with PS 2 or worse at initial referral and the start of chemotherapy; and 3) patients with PS 0 or 1 at referral that deteriorated to PS 2 or worse at the start of chemotherapy. The prognoses of Groups 2 and 3 were compared with those of Group 1. Results: A total of 373 patients were included: 321 in Group 1, 20 in Group 2, and 32 in Group 3. The median overall survival (OS) of Group 3 was shorter than that of Group 1 (9.3 vs. 27.1 months, hazard ratio [HR] 2.56, p < 0.01). The median OS of Group 2 was also shorter than that of Group 1, although not as significant as in Group 3 (20.2 vs. 27.1 months, HR 1.68, p = 0.06). After adjusting for symptoms, liver and pericardial metastases were associated with PS deterioration in multivariate analysis. Conclusion: Among patients with untreated advanced NSCLC, acute PS deterioration before chemotherapy administration was associated with poor prognosis.