Performance status and sensitivity to first-line chemotherapy are significant prognostic factors in patients with recurrent small cell lung cancer receiving second-line chemotherapy

Abstract

Background: To the authors' knowledge, the prognostic factors in recurrent small cell lung cancer (SCLC) patients treated with second-line chemotherapy have not yet been clearly identified to date.

Methods: Between July 1992 and December 2003, 232 of 515 patients who were diagnosed to have SCLC at the National Cancer Center Hospital East were administered second-line chemotherapy for recurrent disease. The authors retrospectively analyzed the relation between clinical factors evaluated at the time of recurrence and the response to second-line chemotherapy or survival in these patients.

Results: The results of univariate analyses revealed that response was significantly associated with the performance status (PS) alone, whereas survival was significantly associated with the PS, disease extent, and sensitivity to first-line chemotherapy. Multivariate analysis identified PS (P< .0001) and sensitivity to first-line chemotherapy (P= .0024) as the independent prognostic factors for survival. When the patients were grouped according to these 2 significant prognostic factors, the survival of patients with a PS of 0 to 1 was significantly better than that of the patients with a PS of 2 to 4 both among cases that were sensitive and those that were refractory to first-line chemotherapy. Although the survival of sensitive recurrent cases was significantly better than that of the refractory recurrent cases among the patients with a PS of 0 to 1 patients, no survival difference was observed between the sensitive and refractory recurrent cases in the patients with a PS of 2 to 4.

Conclusions: Both PS and sensitivity to initial chemotherapy were found to be significant prognostic factors for survival in recurrent SCLC patients treated with second-line chemotherapy. These 2 factors should therefore be used as stratification factors in future clinical trials.