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. 2016 Mar 8:16:197.
doi: 10.1186/s12885-016-2222-4.

Prognostic factors affecting the risk of thoracic progression in extensive-stage small cell lung cancer

Tomoya Fukui  1 , Michiko Itabashi  2 , Mikiko Ishihara  3 , Yasuhiro Hiyoshi  4 , Masashi Kasajima  5 , Satoshi Igawa  6 , Jiichiro Sasaki  7 , Noriyuki Masuda  8
Affiliations

Prognostic factors affecting the risk of thoracic progression in extensive-stage small cell lung cancer

Tomoya Fukui et al. BMC Cancer. .

Abstract

Background: The efficacy of combined modality therapy is evaluated for patients with extensive-stage (ES) small cell lung cancer (SCLC). This study evaluated prognostic factors affecting the risk of thoracic progression in ES-SCLC patients likely to undergo thoracic radiotherapy combined chemotherapy.

Methods: A retrospective review of ES-SCLC patients who had received systemic chemotherapy at our hospital was performed. Tumor size, metastatic sites, and laboratory data at diagnosis were evaluated as potential prognostic factors. In ES-SCLC patients without pleural dissemination, the rate of thoracic progression after initial chemotherapy was assessed.

Results: Eighty-three of 96 consecutive ES-SCLC patients were analyzed. The overall response rate was 55 %, median progression free survival was 5.0 months (mo), and overall survival (OS) was 9.2 mo. Tumor size (19.4 mo for ≤3 cm vs. 8.5 mo for >3 cm, p = 0.017) and the number of metastatic sites (12.9 mo for single sites vs. 7.1 mo for multiple sites, p = 0.015) were prognostic factors, in addition to known prognostic factors such as performance status and the levels of LDH and sodium. Cox proportional hazard model showed that the OS was significantly worse in patients with large (>3 cm) primary tumor size {HR 2.44 [95 % confidential interval (CI) 1.05-5.68], p = 0.038} and multiple metastatic sites [HR 1.81 (95 % CI 1.08-3.04), p = 0.026]. In 51 cases without pleural dissemination, the number of metastatic sites was associated with thoracic progression after initial chemotherapy (65 % for single sites vs. 36 % for multiple sites, p = 0.036).

Conclusion: Large tumor size and multiple metastatic sites at diagnosis significantly predicted poor survival in ES-SCLC patients. Based on the high rate of thoracic progression in ES-SCLC patients with single site of distant metastasis, we should consider thoracic radiotherapy combined with chemotherapy for this population.

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Figures

Fig. 1
Fig. 1
Kaplan–Meier Analysis-based Estimates of Survival Based on Prognostic Factors. 1-1. Comparison of survival between patients having small (≤3 cm) primary tumors (blue) and those having large (>3 cm) primary tumors (red). 1-2. Comparison of survival between patients having single sites of a distant metastasis (blue) and those having multiple (two or more) sites of distant metastases (red). P-values were determined by the log-rank test; the number of individuals and the survival times (median (95 % confidence interval), months (mo)) in each group are indicated
Fig. 2
Fig. 2
Disease Progression after First-line Chemotherapy in ES-SCLC Patients without Pleural Effusion (n = 51). Rates (%) of recurrence patterns based on primary tumor size (≤3 cm vs. >3 cm; 2-1) and the number of metastatic sites (single metastasis vs. multiple metastases; 2-2) at diagnosis are shown. Blue: thoracic progression, Red: metastases to a distant site, Green: metastases to multiple sites including pleural dissemination and carcinomatous lymphangiosis, Purple: not evaluable
See this image and copyright information in PMC

References

    1. van Meerbeeck JP, Fennell DA, De Ruysscher DK. Small-cell lung cancer. Lancet. 2011;378(9804):1741–55. doi: 10.1016/S0140-6736(11)60165-7. - DOI - PubMed
    1. Jett JR, Schild SE, Kesler KA, Kalemkerian GP. Treatment of small cell lung cancer: Diagnosis and management of lung cancer, 3rd ed: American College of Chest Physicians evidence-based clinical practice guidelines. Chest. 2013;143(5 Suppl):e400S–19. doi: 10.1378/chest.12-2363. - DOI - PubMed
    1. Socinski MA, Bogart JA. Limited-stage small-cell lung cancer: the current status of combined-modality therapy. J Clin Oncol Off J Am Soc Clin Oncol. 2007;25(26):4137–45. doi: 10.1200/JCO.2007.11.5303. - DOI - PubMed
    1. Takada M, Fukuoka M, Kawahara M, Sugiura T, Yokoyama A, Yokota S, et al. Phase III study of concurrent versus sequential thoracic radiotherapy in combination with cisplatin and etoposide for limited-stage small-cell lung cancer: results of the Japan Clinical Oncology Group Study 9104. J Clin Oncol Off J Am Soc Clin Oncol. 2002;20(14):3054–60. doi: 10.1200/JCO.2002.12.071. - DOI - PubMed
    1. De Ruysscher D, Pijls-Johannesma M, Bentzen SM, Minken A, Wanders R, Lutgens L, et al. Time between the first day of chemotherapy and the last day of chest radiation is the most important predictor of survival in limited-disease small-cell lung cancer. J Clin Oncol Off J Am Soc Clin Oncol. 2006;24(7):1057–63. doi: 10.1200/JCO.2005.02.9793. - DOI - PubMed

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