Table 2– Summary of the recommendations based on level of evidence, quality of evidence and grade of recommendation (Grades of Recommendation Assessment, Development and Evaluation system)
RecommendationLevel of evidenceQuality of evidenceGrade of recommendation
1.1) Time-to-progression is an intermediate marker for overall survival in advanced NSCLC treated with first-line chemotherapyMA3Fs
1.2) Progression-free survival is a potential intermediate marker for survival in the setting of docetaxel or vinca-alcaloids first-line based regimensMA2Fw
2.1) Objective response is an intermediate criterion for overall survival in advanced NSCLC treated with first-line or salvage chemotherapyMA/RT4Fs
2.2) Objective response is an intermediate criterion for overall survival in extensive disease SCLC treated with first-line chemotherapyMA/ReS2Fw
2.3) Objective response is a potential intermediate criterion for overall survival in operable NSCLC treated with induction chemotherapy and in locoregionally advanced NSCLC treated by chemotherapy and radiotherapyReS2Fw
3.1) Although commonly used, conventional criteria for response assessment of primary lung tumour treated by (chemo)radiotherapy cannot be used as intermediate criteria for survivalReS1Aw
3.2) Local control, for which the definition has to be clarified, may be a possible intermediate criterion for overall survivalReS1Fw
4) Response at the QoL level cannot be recommended as an intermediate criterion for overall survival due to a lack of robust dataReS1Aw
5) Although not strictly demonstrated, there are numerous arguments from subgroup analyses of randomised trials and retrospective studies that mediastinal downstaging and, to a lesser extent, TN downstaging are associated with better survival in locally advanced NSCLC treated by induction chemotherapy or chemoradiotherapy before surgeryReS2Fw
6.1) Complete resection is a prognostic factor for survival in resected NSCLC and can be used as an intermediate criterion for overall survivalCohort/ReS3Fs
6.2) Pathological TNM is a prognostic factor for survival in resected NSCLC and can be used as an intermediate criterion for overall survivalCohort3Fs
7) Metabolic response assessed by PET scan should not be used for the routine assessment of response to treatment in lung cancer patients in place of morphological criteriaReS/CS1Aw
8) Tissue biological markers have not to be used for evaluation of treatment efficacy and are not adequate intermediate criteria for overall survival in lung cancer patientsCS1Aw
9.1) It is suggested that some circulating markers (CEA, Cyfra 21-1 and pro-GRP, and to a lesser extent NSE, CA-125 and CA19-9), used as single criterion to assess overall survival, could be adequate intermediate criteria for survival in lung cancer patientsReS2Fw
9.2) The persistence of circulating tumour cells in NSCLC may have a prognostic impact on further survivalCohort1Fw

  • NSCLC: nonsmall cell lung cancer; SCLC: small cell lung cancer; QoL: quality of life; PET: positron emission tomography; CEA: carcinoembryonic antigen; pro-GRP: pro-gastrin releasing peptide; NSE: neurone-specific enolase; MA: meta-analysis; RT: randomised trial; ReS: retrospective studies; CS: case series; Fs: strong recommendation for using an intervention; Fw: weak recommendation for using an intervention; Aw: weak recommendation against using an intervention.