Abstract

Introduction: Primary lung cancer is the leading cause of malignant thoracic tumors in Tunisia. Only 20 to 30% of patients are diagnosed at a locally advanced stage. The aim of our study was to evaluate the therapeutic management and identify prognostic factors at this stage

Methods : We performed a retrospective study, including 132 patients diagnosed with stage III non-small cell lung cancer hospitalized in Ibn Nafis pulmonology department of Abderrahmane Mami Hospital between 2016 and 2019

Results:Therapeutic decision was made at the multidisciplinary meeting in 56.8% of cases. Twenty-seven percent of our patients had surgery. Surgical procedure was lobectomy in 66.7% of cases. Chemo-radiotherapy was prescribed for 53.1% of patients; concurrent in 33.3% and sequential in 66.7% of cases.The median overall survival was 18.3 ± 1.3 months with a median progression-free survival of 8 months ± 0.6 months. In univariate analysis, the factors interfering with overall survival were: age (p=0.048), initial PS (p=0.024) and its evolution (p=0.026), histologic type (p=0.015), stage of the disease (p=0.02), lymph node extension (p=0.001), surgery (p=0.018), concurrent chemo-radiotherapy (p=0.008), time to consultation under 60 days (p=0.008) and dose of morphine over 150 mg/day (p=0.001). In multivariate analysis,the initial PS (p=0.013),the stage (p=0.02), lymph node extension (p=0.015), curative surgery (p=0.017) and concurrent chemo-radiotherapy (p= 0.001) were the independent factors identified.

Conclusion:Several modifiable and exogenous factors to natural evolution of locally advanced lung cancer have an impact on overall survival. Managing and improving patient journey times throughout their care is a priority