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Hou Q, Liang Y, Yao N, Liu J, Cao X, Zhang S, Wei L, Sun B, Feng P, Zhang W, Cao J. Development of a novel nomogram for patients with SCLC and comparison with other models. BMC Cancer 2024; 24:1257. [PMID: 39390375 PMCID: PMC11465591 DOI: 10.1186/s12885-024-12791-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2022] [Accepted: 08/09/2024] [Indexed: 10/12/2024] Open
Abstract
BACKGROUND Though several nomograms have been established to predict the survival probability of patients with small-cell lung cancer (SCLC), none involved enough variables. This study aimed to construct a novel prognostic nomogram and compare its performance with other models. METHODS Seven hundred twenty-two patients were pathologically diagnosed with SCLC in Shanxi Province Cancer Hospital, Shanxi Hospital Affiliated to Cancer Hospital, Chinese Academy of Medical Sciences, Cancer Hospital Affiliated to Shanxi Medical University from January 2016 to December 2018. We input Forty-one factors by reviewing the medical records. The nomogram was constructed based on the variables identified by univariate and multivariate analyses in the training set and validated in the validation set. Then we compared the performance of the models in terms of discrimination, calibration, and clinical net benefit. RESULTS There were eight variables involved in the nomogram: gender, monocyte (MON), neuron-specific enolase (NSE), cytokeratin 19 fragments (Cyfra211), M stage, radiotherapy (RT), chemotherapy cycles (CT cycles), and prophylactic cranial irradiation (PCI). The calibration curve showed a good correlation between the nomogram prediction and actual observation for overall survival (OS). The area under the curve (AUC) of the nomogram was higher, and the Integrated Brier score (IBS) was lower than other models, indicating a more accurate prediction. Decision curve analysis (DCA) showed a significant improvement in the clinical net benefit compared to the other models. CONCLUSIONS We constructed a novel nomogram to predict OS for patients with SCLC using more comprehensive and objective variables. It performed better than existing models and would assist clinicians in individually estimating risk and making a therapeutic regimen.
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Affiliation(s)
- Qing Hou
- Department of Radiotherapy, Shanxi Province Cancer Hospital, Shanxi Hospital Affiliated to Cancer Hospital, Chinese Academy of Medical Sciences, Cancer Hospital Affiliated to Shanxi Medical University, No.3, Zhigongxin Street, Taiyuan, Shanxi, 030010, China
| | - Yu Liang
- Department of Radiotherapy, Shanxi Province Cancer Hospital, Shanxi Hospital Affiliated to Cancer Hospital, Chinese Academy of Medical Sciences, Cancer Hospital Affiliated to Shanxi Medical University, No.3, Zhigongxin Street, Taiyuan, Shanxi, 030010, China
| | - Ningning Yao
- Department of Radiotherapy, Shanxi Province Cancer Hospital, Shanxi Hospital Affiliated to Cancer Hospital, Chinese Academy of Medical Sciences, Cancer Hospital Affiliated to Shanxi Medical University, No.3, Zhigongxin Street, Taiyuan, Shanxi, 030010, China
| | - Jianting Liu
- Department of Radiotherapy, Shanxi Province Cancer Hospital, Shanxi Hospital Affiliated to Cancer Hospital, Chinese Academy of Medical Sciences, Cancer Hospital Affiliated to Shanxi Medical University, No.3, Zhigongxin Street, Taiyuan, Shanxi, 030010, China
| | - Xin Cao
- Department of Radiotherapy, Shanxi Province Cancer Hospital, Shanxi Hospital Affiliated to Cancer Hospital, Chinese Academy of Medical Sciences, Cancer Hospital Affiliated to Shanxi Medical University, No.3, Zhigongxin Street, Taiyuan, Shanxi, 030010, China
| | - Shuangping Zhang
- Department of Thoracic Surgery, Shanxi Province Cancer Hospital, Shanxi Hospital Affiliated to Cancer Hospital, Chinese Academy of Medical Sciences, Cancer Hospital Affiliated to Shanxi Medical University, No.3, Zhigongxin Street, Taiyuan, Shanxi, 030013, China
| | - Lijuan Wei
- Department of Radiotherapy, Shanxi Province Cancer Hospital, Shanxi Hospital Affiliated to Cancer Hospital, Chinese Academy of Medical Sciences, Cancer Hospital Affiliated to Shanxi Medical University, No.3, Zhigongxin Street, Taiyuan, Shanxi, 030010, China
| | - Bochen Sun
- Department of Radiotherapy, Shanxi Province Cancer Hospital, Shanxi Hospital Affiliated to Cancer Hospital, Chinese Academy of Medical Sciences, Cancer Hospital Affiliated to Shanxi Medical University, No.3, Zhigongxin Street, Taiyuan, Shanxi, 030010, China
| | - Peixin Feng
- Department of Radiotherapy, Shanxi Province Cancer Hospital, Shanxi Hospital Affiliated to Cancer Hospital, Chinese Academy of Medical Sciences, Cancer Hospital Affiliated to Shanxi Medical University, No.3, Zhigongxin Street, Taiyuan, Shanxi, 030010, China
| | - Wenjuan Zhang
- Department of Radiotherapy, Shanxi Province Cancer Hospital, Shanxi Hospital Affiliated to Cancer Hospital, Chinese Academy of Medical Sciences, Cancer Hospital Affiliated to Shanxi Medical University, No.3, Zhigongxin Street, Taiyuan, Shanxi, 030010, China
| | - Jianzhong Cao
- Department of Radiotherapy, Shanxi Province Cancer Hospital, Shanxi Hospital Affiliated to Cancer Hospital, Chinese Academy of Medical Sciences, Cancer Hospital Affiliated to Shanxi Medical University, No.3, Zhigongxin Street, Taiyuan, Shanxi, 030010, China.
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Yu SC, Huang JY, Cheng YF, Cheng CY, Huang CL, Hu WH, Wang BY. Prognostic factors in clinical stage IIIA small cell lung cancer: An analysis of a population-based cancer registry in Taiwan. PLoS One 2024; 19:e0297399. [PMID: 39208297 PMCID: PMC11361662 DOI: 10.1371/journal.pone.0297399] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2024] [Accepted: 07/14/2024] [Indexed: 09/04/2024] Open
Abstract
Lung cancer stands as the primary cause of cancer-related death across the globe. The standard therapeutic approach for lung cancer involves concurrent chemoradiotherapy, with consideration of prophylactic cranial irradiation for younger or well-performing patients. In this study, we aimed to investigate prognostic factors and the impacts of different treatment methods on overall survival for stage IIIA small cell lung cancer in Taiwan. We obtained data from the Taiwan Cancer Registry, which included clinical and pathology data of 579 stage IIIA small cell lung cancer patients from January 2010 to December 2018, for this retrospective study. The enrolled patients had data on age, sex, Charlson Comorbidity Index score, histologic grading, clinical T, clinical N, clinical stage, treatment modality, and overall survival time. We compared overall survival among different subgroups to assess the impacts of these prognostic factors. The five-year survival rate for all patients was 20.57%, with a median survival time of 15.79 months. The data suggest that Charlson Comorbidity Index score, histologic grade, and clinical stage subgroups did not reach statistically significant differences. During the multivariate analysis, age over 70 years, sex, and treatment method were determined to be statistically significant independent prognostic factors. Patients who underwent surgical intervention exhibited significantly better outcomes compared to those who did not undergo operation.. In conclusion, stage IIIA small cell lung cancer is a highly heterogeneous disease. Operation should be considered as one of the alternative treatments in stage IIIA Small cell lung cancer patients.
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Affiliation(s)
- Sung-Chi Yu
- Division of Thoracic Surgery, Department of Surgery, Changhua Christian Hospital, Changhua, Taiwan
| | - Jing-Yang Huang
- Institute of Medicine, Chung Shan Medical University, Taichung, Taiwan
- Center for Health Data Science, Chung Shan Medical University Hospital, Taichung, Taiwan
| | - Ya-Fu Cheng
- Division of Thoracic Surgery, Department of Surgery, Changhua Christian Hospital, Changhua, Taiwan
| | - Ching-Yuan Cheng
- Division of Thoracic Surgery, Department of Surgery, Changhua Christian Hospital, Changhua, Taiwan
- Department of Post-Baccalaureate Medicine, College of Medicine, National Chung Hsing University, Taichung, Taiwan
| | - Chang-Lun Huang
- Division of Thoracic Surgery, Department of Surgery, Changhua Christian Hospital, Changhua, Taiwan
| | - Wei-Heng Hu
- Division of Thoracic Surgery, Department of Surgery, Changhua Christian Hospital, Changhua, Taiwan
| | - Bing-Yen Wang
- Division of Thoracic Surgery, Department of Surgery, Changhua Christian Hospital, Changhua, Taiwan
- Department of Post-Baccalaureate Medicine, College of Medicine, National Chung Hsing University, Taichung, Taiwan
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Zhang T, Tao L, Chen Y, Zhang S, Liu Y, Li Y, Wang R. Evaluation of Efficacy and Safety in First-Line Treatment Methods for Extensive-Stage Small Cell Lung Cancer: A Comprehensive Comparative Study of Chemotherapy, Targeted Therapy Combined With Chemotherapy, and Immunotherapy Combined With Chemotherapy. THE CLINICAL RESPIRATORY JOURNAL 2024; 18:e13819. [PMID: 39118429 PMCID: PMC11310407 DOI: 10.1111/crj.13819] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/03/2023] [Revised: 07/16/2024] [Accepted: 07/19/2024] [Indexed: 08/10/2024]
Abstract
BACKGROUND Small cell lung cancer (SCLC) is a highly aggressive tumor with limited effectiveness in its standard chemotherapy treatment. Targeted antiangiogenic therapy and immune checkpoint inhibitors (ICIs) have demonstrated potential as alternative treatments for extensive-stage SCLC (ES-SCLC). However, there is insufficient comparative evidence available to determine the optimal first-line treatment option between ICIs plus chemotherapy and targeted antiangiogenic therapy plus chemotherapy. OBJECTIVE This study is aimed at analyzing clinical data from ES-SCLC patients treated at the First Affiliated Hospital of Bengbu Medical College between June 2021 and June 2023. The study compared the efficacy and safety of three first-line treatment regimens: standard chemotherapy, antiangiogenic therapy combined with chemotherapy, and immune combination therapy. METHODS Patients who met the inclusion criteria were divided into three groups: chemotherapy, immune combination therapy, and antiangiogenic therapy combined with chemotherapy. The study collected data on clinical characteristics, treatment regimens, and adverse reactions. The analysis included objective response rate (ORR), duration of response (DoR), disease control rate (DCR), progression-free survival (PFS), and treatment safety. RESULTS A total of 101 patients were included in the study, with 49 receiving chemotherapy alone, 19 receiving antiangiogenic therapy, and 33 receiving immune combination therapy. The ORRs were 78.9% for antiangiogenic therapy, 72.7% for immune combination therapy, and 42.9% for chemotherapy alone. The median PFS was 8.0 months for antiangiogenic therapy, 7.8 months for immune combination therapy, and 5.2 months for chemotherapy alone. Both combination therapy groups demonstrated superior efficacy compared to chemotherapy alone. CONCLUSION Targeted combined chemotherapy and immune combination chemotherapy showed superior efficacy as first-line treatments for ES-SCLC compared to chemotherapy alone, with manageable adverse reactions.
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Affiliation(s)
- Tiantian Zhang
- Departments of Medical OncologyThe First Affiliated Hospital of Bengbu Medical CollegeBengbuAnhuiPeople's Republic of China
| | - Lu Tao
- Departments of Medical OncologyThe First Affiliated Hospital of Bengbu Medical CollegeBengbuAnhuiPeople's Republic of China
| | - Yufo Chen
- Departments of Medical OncologyThe First Affiliated Hospital of Bengbu Medical CollegeBengbuAnhuiPeople's Republic of China
| | - Shanshan Zhang
- Departments of Medical OncologyThe First Affiliated Hospital of Bengbu Medical CollegeBengbuAnhuiPeople's Republic of China
| | - Yang Liu
- Departments of Medical OncologyThe First Affiliated Hospital of Bengbu Medical CollegeBengbuAnhuiPeople's Republic of China
| | - Yumei Li
- Departments of Medical OncologyThe First Affiliated Hospital of Bengbu Medical CollegeBengbuAnhuiPeople's Republic of China
| | - Rui Wang
- Departments of Medical OncologyThe First Affiliated Hospital of Bengbu Medical CollegeBengbuAnhuiPeople's Republic of China
- Anhui Provincial Key Laboratory of Cancer Translational MedicineThe First Affiliated Hospital of Bengbu Medical CollegeBengbuAnhuiPeople's Republic of China
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Park JE, Campbell H, Towle K, Yuan Y, Jansen JP, Phillippo D, Cope S. Unanchored Population-Adjusted Indirect Comparison Methods for Time-to-Event Outcomes Using Inverse Odds Weighting, Regression Adjustment, and Doubly Robust Methods With Either Individual Patient or Aggregate Data. VALUE IN HEALTH : THE JOURNAL OF THE INTERNATIONAL SOCIETY FOR PHARMACOECONOMICS AND OUTCOMES RESEARCH 2024; 27:278-286. [PMID: 38135212 DOI: 10.1016/j.jval.2023.11.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/10/2023] [Revised: 10/18/2023] [Accepted: 11/15/2023] [Indexed: 12/24/2023]
Abstract
OBJECTIVES Several methods for unanchored population-adjusted indirect comparisons (PAICs) are available. Exploring alternative adjustment methods, depending on the available individual patient data (IPD) and the aggregate data (AD) in the external study, may help minimize bias in unanchored indirect comparisons. However, methods for time-to-event outcomes are not well understood. This study provides an overview and comparison of methods using a case study to increase familiarity. A recent method is applied to marginalize conditional hazard ratios, which allows for the comparisons of methods, and a doubly robust method is proposed. METHODS The following PAIC methods were compared through a case study in third-line small cell lung cancer, comparing nivolumab with standard of care based on a single-arm phase II trial (CheckMate 032) and real-world study (Flatiron) in terms of overall survival: IPD-IPD analyses using inverse odds weighting, regression adjustment, and a doubly robust method; IPD-AD analyses using matching-adjusted indirect comparison, simulated treatment comparison, and a doubly robust method. RESULTS Nivolumab extended survival versus standard of care with hazard ratios ranging from 0.63 (95% CI 0.44-0.90) in naive comparisons (identical estimates for IPD-IPD and IPD-AD analyses) to 0.69 (95% CI 0.44-0.98) in the IPD-IPD analyses using regression adjustment. Regression-based and doubly robust estimates yielded slightly wider confidence intervals versus the propensity score-based analyses. CONCLUSIONS The proposed doubly robust approach for time-to-event outcomes may help to minimize bias due to model misspecification. However, all methods for unanchored PAIC rely on the strong assumption that all prognostic covariates have been included.
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Affiliation(s)
- Julie E Park
- PRECISIONheor, Evidence Synthesis and Decision Modeling, Vancouver, BC, Canada
| | - Harlan Campbell
- PRECISIONheor, Evidence Synthesis and Decision Modeling, Vancouver, BC, Canada; University of British Columbia, Vancouver, BC, Canada
| | - Kevin Towle
- PRECISIONheor, Evidence Synthesis and Decision Modeling, Vancouver, BC, Canada
| | - Yong Yuan
- Worldwide Health Economics and Outcomes Research, Bristol Myers Squibb, Princeton, NJ, USA
| | - Jeroen P Jansen
- PRECISIONheor, Evidence Synthesis and Decision Modeling, Vancouver, BC, Canada
| | - David Phillippo
- University of Bristol, Bristol Medical School, Bristol, England, UK
| | - Shannon Cope
- PRECISIONheor, Evidence Synthesis and Decision Modeling, Vancouver, BC, Canada.
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Kwon YJ, Yoon YC, Kim HS, Cha MJ, Park S, Lee JH. Prognostic significance of body mass index in small-cell lung cancer: Exploring the relationship with skeletal muscle status. J Cachexia Sarcopenia Muscle 2023; 14:2939-2947. [PMID: 37986687 PMCID: PMC10751438 DOI: 10.1002/jcsm.13345] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2023] [Revised: 08/25/2023] [Accepted: 09/12/2023] [Indexed: 11/22/2023] Open
Abstract
BACKGROUND We investigated the prognostic significance of body mass index in small-cell lung cancer and explored whether skeletal muscle status affects the body mass index-survival relationship. METHODS This retrospective study evaluated data from patients who underwent platinum-etoposide chemotherapy for small-cell lung cancer between March 2010 and December 2021. Skeletal muscle status was assessed using non-contrast computed tomography images of baseline positron-emission tomography-computed tomography, with the skeletal muscle index defined as the cross-sectional area of skeletal muscle divided by height squared, and the average attenuation values of skeletal muscle. Cox proportional hazards regression analysis was used to determine the correlations of body mass index, skeletal muscle metrics, and overall survival. RESULTS We analysed the data of 1146 Asian patients (1006 men and 140 women, with a median age of 67 years [interquartile range: 61-72 years]), including 507 and 639 patients with limited and extensive disease, respectively. Being underweight, defined as a body mass index <18.5 kg/m2 , was associated with shorter overall survival, independent of clinical covariates in both the limited-disease (hazard ratio, 1.77; 95% confidence interval, 1.01-3.09) and extensive-disease (hazard ratio, 1.71; 95% confidence interval, 1.18-2.48) groups. The prognostic value of being underweight remained significant after additional adjustment for skeletal muscle index and attenuation in both limited-disease (hazard ratio, 1.96; 95% confidence interval, 1.09-3.51) and extensive-disease (hazard ratio, 1.75; 95% confidence interval, 1.17-2.61) groups. CONCLUSIONS Being underweight is an independent poor prognostic factor for shorter overall survival in Asian patients with small-cell lung cancer, regardless of skeletal muscle status.
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Affiliation(s)
- Yong Jae Kwon
- Department of Radiology, Samsung Medical CenterSungkyunkwan University School of MedicineSeoulRepublic of Korea
| | - Young Cheol Yoon
- Department of Radiology, Samsung Medical CenterSungkyunkwan University School of MedicineSeoulRepublic of Korea
| | - Hyun Su Kim
- Department of Radiology, Samsung Medical CenterSungkyunkwan University School of MedicineSeoulRepublic of Korea
| | - Min Jae Cha
- Department of Radiology, Chung‐Ang University HospitalChung‐Ang University College of MedicineSeoulRepublic of Korea
| | - Sehhoon Park
- Department of Medicine, Division of Hematology‐Oncology, Samsung Medical CenterSungkyunkwan University School of MedicineSeoulRepublic of Korea
| | - Ji Hyun Lee
- Department of Radiology, Samsung Medical CenterSungkyunkwan University School of MedicineSeoulRepublic of Korea
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Wu S, Guan W, Zhao H, Li G, Zhou Y, Shi B, Zhang X. Prognostic role of short-term heart rate variability and deceleration/acceleration capacities of heart rate in extensive-stage small cell lung cancer. Front Physiol 2023; 14:1277383. [PMID: 38028778 PMCID: PMC10663334 DOI: 10.3389/fphys.2023.1277383] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2023] [Accepted: 10/26/2023] [Indexed: 12/01/2023] Open
Abstract
Background: Prior research suggests that autonomic modulation investigated by heart rate variability (HRV) might act as a novel predictive biomarker for cancer prognosis, such as in breast cancer and pancreatic cancer. It is not clear whether there is a correlation between autonomic modulation and prognosis in patients with extensive-stage small cell lung cancer (ES-SCLC). Therefore, the purpose of the study was to examine the association between short-term HRV, deceleration capacity (DC) and acceleration capacity (AC) of heart rate and overall survival in patients with ES-SCLC. Methods: We recruited 40 patients with ES-SCLC, and 39 were included in the final analysis. A 5-min resting electrocardiogram of patients with ES-SCLC was collected using a microelectrocardiogram recorder to analyse short-term HRV, DC and AC. The following HRV parameters were used: standard deviation of the normal-normal intervals (SDNN) and root mean square of successive interval differences (RMSSD). Overall survival of patients with ES-SCLC was defined as time from the date of electrocardiogram measurement to the date of death or the last follow-up. Follow-up was last performed on 07 June 2023. There was a median follow-up time of 42.2 months. Results: Univariate analysis revealed that the HRV parameter SDNN, as well as DC significantly predicted the overall survival of ES-SCLC patients (all p < 0.05). Multivariate analysis showed that the HRV parameters SDNN (hazard ratio = 5.254, 95% CI: 1.817-15.189, p = 0.002), RMSSD (hazard ratio = 3.024, 95% CI: 1.093-8.372, p = 0.033), as well as DC (hazard ratio = 3.909, 95% CI: 1.353-11.293, p = 0.012) were independent prognostic factors in ES-SCLC patients. Conclusion: Decreased HRV parameters (SDNN, RMSSD) and DC are independently associated with shorter overall survival in ES-SCLC patients. Autonomic nervous system function (assessed based on HRV and DC) may be a new biomarker for evaluating the prognosis of patients with ES-SCLC.
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Affiliation(s)
- Shuang Wu
- School of Medicine, Yangzhou University, Yangzhou, Jiangsu, China
- Department of Radiation Oncology, First Affiliated Hospital, Bengbu Medical College, Bengbu, Anhui, China
| | - Weizheng Guan
- School of Medical Imaging, Bengbu Medical College, Bengbu, Anhui, China
- Anhui Key Laboratory of Computational Medicine and Intelligent Health, Bengbu Medical College, Bengbu, Anhui, China
| | - Huan Zhao
- School of Medical Imaging, Bengbu Medical College, Bengbu, Anhui, China
- Anhui Key Laboratory of Computational Medicine and Intelligent Health, Bengbu Medical College, Bengbu, Anhui, China
| | - Guangqiao Li
- School of Medical Imaging, Bengbu Medical College, Bengbu, Anhui, China
- Anhui Key Laboratory of Computational Medicine and Intelligent Health, Bengbu Medical College, Bengbu, Anhui, China
| | - Yufu Zhou
- Department of Radiation Oncology, First Affiliated Hospital, Bengbu Medical College, Bengbu, Anhui, China
| | - Bo Shi
- School of Medical Imaging, Bengbu Medical College, Bengbu, Anhui, China
- Anhui Key Laboratory of Computational Medicine and Intelligent Health, Bengbu Medical College, Bengbu, Anhui, China
| | - Xiaochun Zhang
- School of Medicine, Yangzhou University, Yangzhou, Jiangsu, China
- Department of Oncology, Yangzhou Hospital of Traditional Chinese Medicine, Yangzhou, Jiangsu, China
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García-Campelo R, Sullivan I, Arriola E, Insa A, Juan Vidal O, Cruz-Castellanos P, Morán T, Reguart N, Zugazagoitia J, Dómine M. SEOM-GECP Clinical guidelines for diagnosis, treatment and follow-up of small-cell lung cancer (SCLC) (2022). Clin Transl Oncol 2023; 25:2679-2691. [PMID: 37418123 PMCID: PMC10425483 DOI: 10.1007/s12094-023-03216-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2023] [Accepted: 05/09/2023] [Indexed: 07/08/2023]
Abstract
Small-cell lung cancer (SCLC) is a highly aggressive malignancy comprising approximately 15% of lung cancers. Only one-third of patients are diagnosed at limited-stage (LS). Surgical resection can be curative in early stages, followed by platinum-etoposide adjuvant therapy, although only a minority of patients with SCLC qualify for surgery. Concurrent chemo-radiotherapy is the standard of care for LS-SCLC that is not surgically resectable, followed by prophylactic cranial irradiation (PCI) for patients without progression. For extensive-stage (ES)-SCLC, a combination of platinum and etoposide has historically been a mainstay of treatment. Recently, the efficacy of programmed death-ligand 1 inhibitors combined with chemotherapy has become the new front-line standard of care for ES-SCLC. Emerging knowledge regarding SCLC biology, including genomic characterization and molecular subtyping, and new treatment approaches will potentially lead to advances in SCLC patient care.
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Affiliation(s)
- Rosario García-Campelo
- Department of Medical Oncology, Hospital Universitario A Coruña, Health Research Institute, INIBIC, A Coruña, Spain.
| | - Ivana Sullivan
- Department of Medical Oncology, Hospital de la Santa Creu i Sant Pau, IIB Sant Pau, Barcelona, Spain
- Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Edurne Arriola
- Department of Medical Oncology, Hospital del Mar-CIBERONC, Barcelona, Spain
| | - Amelia Insa
- Departmert of Medical Oncology, Hospital Clínico de Valencia, Valencia, Spain
| | - Oscar Juan Vidal
- Department of Medical Oncology, Hospital Universitari i Politécnic La Fe de Valencia, Valencia, Spain
| | | | - Teresa Morán
- Department of Medical Oncology, Badalona Applied Research Group in Oncology, Catalan Institute of Oncology Badalona, Hospital Universitario Germans Trias i Pujol, Institut Germans Trias i Pujol, Barcelona, Spain
- Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Noemí Reguart
- Department of Medical Oncology, Hospital Clinic, Barcelona, Spain
| | - Jon Zugazagoitia
- Department of Medical Oncology, Tumor Microenvironment and Immunotherapy Research Group, Hospital Universitario 12 de Octubre, Madrid, Health Research Institute Hospital Universitario 12 de Octubre (i+12), H12O-CNIO Lung Cancer Clinical Research Unit, Health Research Institute, CIBERONC, Madrid, Spain
| | - Manuel Dómine
- Department of Medical Oncology. Hospital, Universitario Fundación Jiménez Díaz, IIS-FJD, Oncohealth Institute, Universidad Autónoma de Madrid, Madrid, Spain
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Kim JS, Kim EJ, Jang JG, Hong KS, Ahn JH. Low diffusion capacity predicts poor prognosis in extensive stage small cell lung cancer: a single-center analysis of 10 years. J Cancer Res Clin Oncol 2023; 149:7275-7283. [PMID: 36912944 PMCID: PMC10374757 DOI: 10.1007/s00432-023-04686-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2023] [Accepted: 03/05/2023] [Indexed: 03/14/2023]
Abstract
BACKGROUND Poor pulmonary function and chronic obstructive pulmonary disease (COPD) are associated with poorer overall survival (OS) in non-small-cell lung cancer (NSCLC) patients. Few studies have investigated the association between pulmonary function and OS in small-cell lung cancer (SCLC) patients. We compared the clinical characteristics of extensive disease SCLC (ED-SCLC) with or without moderately impaired diffusion capacity for carbon monoxide (DLco) and investigated the factors associated with survival in ED-SCLC patients. METHODS This retrospective single-center study was performed between January 2011 and December 2020. Of the 307 SCLC patients who received cancer therapy during the study, 142 with ED-SCLC were analyzed. The patients were divided into DLco < 60% group and DLco ≥ 60% groups. OS and predictors of poor OS were analyzed. RESULTS The median OS of the 142 ED-SCLC patients was 9.3 months and the median age was 68 years. In total, 129 (90.8%) patients had a history of smoking, and 60 (42.3%) had COPD. Thirty-five (24.6%) patients were assigned to the DLco < 60% group. Multivariate analysis revealed that DLco < 60% (odds ratio [OR], 1.609; 95% confidence interval [CI], 1.062-2.437; P = 0.025), number of metastases (OR, 1.488; 95% CI, 1.262-1.756; P < 0.001), and < 4 cycles of first-line chemotherapy (OR, 3.793; 95% CI, 2.530-5.686; P < 0.001) were associated with poor OS. Forty (28.2%) patients received < 4 cycles of first-line chemotherapy; the most common reason for this was death (n = 22, 55%) from grade 4 febrile neutropenia (n = 15), infection (n = 5), or massive hemoptysis (n = 2). The DLco < 60% group had a shorter median OS than the DLco ≥ 60% group (10.6 ± 0.8 vs. 4.9 ± 0.9 months, P = 0.003). CONCLUSIONS In this study, approximately one quarter of the ED-SCLC patients had DLco < 60%. Low DLco (but not forced expiratory volume in 1 s or forced vital capacity), a large number of metastases, and < 4 cycles of first-line chemotherapy were independent risk factors for poor survival outcomes in patients with ED-SCLC.
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Affiliation(s)
- Jee Seon Kim
- Division of Pulmonology, Department of Internal Medicine, Pohang Semyeong Christianity Hospital, Pohang, Republic of Korea
| | - Eun Ji Kim
- Division of Pulmonology and Allergy, Department of Internal Medicine, College of Medicine, Yeungnam University and Respiratory Center, Yeungnam University Medical Center, 170 Hyeonchung-Ro, Namgu, Daegu, 42415, Republic of Korea
| | - Jong Geol Jang
- Division of Pulmonology and Allergy, Department of Internal Medicine, College of Medicine, Yeungnam University and Respiratory Center, Yeungnam University Medical Center, 170 Hyeonchung-Ro, Namgu, Daegu, 42415, Republic of Korea
| | - Kyung Soo Hong
- Division of Pulmonology and Allergy, Department of Internal Medicine, College of Medicine, Yeungnam University and Respiratory Center, Yeungnam University Medical Center, 170 Hyeonchung-Ro, Namgu, Daegu, 42415, Republic of Korea.
| | - June Hong Ahn
- Division of Pulmonology and Allergy, Department of Internal Medicine, College of Medicine, Yeungnam University and Respiratory Center, Yeungnam University Medical Center, 170 Hyeonchung-Ro, Namgu, Daegu, 42415, Republic of Korea.
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Nakamichi S, Kubota K, Zou F, Hayashi A, Takano N, Onda N, Matsumoto M, Miyanaga A, Noro R, Seike M. Lower optimal dose of amrubicin for relapsed small-cell lung cancer: a retrospective study. Int J Clin Oncol 2023; 28:872-879. [PMID: 37171692 DOI: 10.1007/s10147-023-02343-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2023] [Accepted: 04/16/2023] [Indexed: 05/13/2023]
Abstract
BACKGROUND Amrubicin (AMR) is one of the most active agents for small-cell lung cancer (SCLC). However, hematologic toxicity and infection at a commonly used dose (40 mg/m2) is problematic; the optimal dose remains undetermined. PATIENTS AND METHODS To evaluate the optimal dose of AMR in terms of efficacy and safety, we reviewed consecutive data on patients with relapsed SCLC who received AMR at doses of 40, 35, and 30 mg/m2 (on days 1-3) at Nippon Medical School Hospital between October 2010 and November 2021. RESULTS We reviewed the data of 86 patients (20, 45, 27 who received AMR doses of 40, 35, 30 mg/m2, respectively) according to our study criteria. For patients ≥ 75 years, the proportion who received second-line treatment tended to be higher in the 30-35 mg/m2 group. Objective response rates were 37/46/35%, median progression-free survival (PFS) were 3.0/4.7/3.2 months, and median overall survival (OS) were 7.8/16.3/8.0 months, respectively. Grade 4 neutropenia occurred in 58/39/31% of patients, which was higher for the 40 mg/m2 group. The incidence of febrile neutropenia did not differ between groups. Multivariate analysis identified the AMR dose was not associated with longer PFS and OS. CONCLUSION Treatment with AMR between 30 and 35 mg/m2 showed relatively mild hematologic toxicity compared with AMR at 40 mg/m2, without any significant difference in efficacy. Lower dose of AMR for relapsed SCLC could be a promising treatment option.
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Affiliation(s)
- Shinji Nakamichi
- Department of Pulmonary Medicine and Oncology, Graduate School of Medicine, Nippon Medical School, 1-1-5, Sendagi, Bunkyo-Ku, Tokyo, 113-8603, Japan.
| | - Kaoru Kubota
- Department of Pulmonary Medicine and Oncology, Graduate School of Medicine, Nippon Medical School, 1-1-5, Sendagi, Bunkyo-Ku, Tokyo, 113-8603, Japan
| | - Fenfei Zou
- Department of Pulmonary Medicine and Oncology, Graduate School of Medicine, Nippon Medical School, 1-1-5, Sendagi, Bunkyo-Ku, Tokyo, 113-8603, Japan
| | - Anna Hayashi
- Department of Pulmonary Medicine and Oncology, Graduate School of Medicine, Nippon Medical School, 1-1-5, Sendagi, Bunkyo-Ku, Tokyo, 113-8603, Japan
| | - Natsuki Takano
- Department of Pulmonary Medicine and Oncology, Graduate School of Medicine, Nippon Medical School, 1-1-5, Sendagi, Bunkyo-Ku, Tokyo, 113-8603, Japan
| | - Naomi Onda
- Department of Pulmonary Medicine and Oncology, Graduate School of Medicine, Nippon Medical School, 1-1-5, Sendagi, Bunkyo-Ku, Tokyo, 113-8603, Japan
| | - Masaru Matsumoto
- Department of Pulmonary Medicine and Oncology, Graduate School of Medicine, Nippon Medical School, 1-1-5, Sendagi, Bunkyo-Ku, Tokyo, 113-8603, Japan
| | - Akihiko Miyanaga
- Department of Pulmonary Medicine and Oncology, Graduate School of Medicine, Nippon Medical School, 1-1-5, Sendagi, Bunkyo-Ku, Tokyo, 113-8603, Japan
| | - Rintaro Noro
- Department of Pulmonary Medicine and Oncology, Graduate School of Medicine, Nippon Medical School, 1-1-5, Sendagi, Bunkyo-Ku, Tokyo, 113-8603, Japan
| | - Masahiro Seike
- Department of Pulmonary Medicine and Oncology, Graduate School of Medicine, Nippon Medical School, 1-1-5, Sendagi, Bunkyo-Ku, Tokyo, 113-8603, Japan
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Abstract
The prognostic significance of body mass index in lung cancer and the direction of this relationship are not yet clear. This study aimed to evaluate the relationship between BMI and overall survival time of advanced-stage lung cancer patients treated in a center in Turkey, a developing country. In this study, the data of 225 patients diagnosed with stage III or stage IV lung cancer between 2016 and 2020 were analyzed. The effects of BMI and other variables on survival were examined by Cox regression analysis for NSCLC and SCLC. For NSCLC and SCLC, being underweight compared to the normal group, being diagnosed at a more advanced stage, and having a worse performance score were associated with a significantly higher risk of death. Other variables significantly associated with survival were gender, type of radiotherapy for NSCLC, age group, and family history for SCLC. This study showed that being underweight relative to the normal group was associated with worse survival for NSCLC and SCLC but did not support the obesity paradox. Studies that are representative of all BMI categories and free of bias are needed to understand the BMI-lung cancer survival relationship clearly.
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Affiliation(s)
- Fatma Yağmur Evcil
- Department of Public Health, Süleyman Demirel University Faculty of Medicine, Isparta, Turkey
| | - Özgür Önal
- Department of Public Health, Süleyman Demirel University Faculty of Medicine, Isparta, Turkey
| | - Emine Elif Özkan
- Department of Radiation Oncology, Süleyman Demirel University Faculty of Medicine, Isparta, Turkey
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11
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Luciani A, Blasi M, Provenzano L, Zonato S, Ferrari D. Recent advances in small cell lung cancer: the future is now? Minerva Endocrinol (Torino) 2022; 47:460-474. [PMID: 33331739 DOI: 10.23736/s2724-6507.20.03213-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
Small cell lung cancer is a relevant clinical issue as it is a highly malignant cancer, often diagnosed in advanced stage. Similarly to non-small cell lung cancer, tobacco smoking is currently the main risk factor. Its incidence, at least in males, has declined over the past decades, due to the worldwide decreased percentage of active smokers. The typical small cells of this tumor type are characterized by a high Proliferation Index, chromosomal deletions such as 3p(14-23) involving the tumor-suppressor gene FHIT, alterations of the MYC or Notch family proteins and the frequent expression of neuroendocrine markers. The combination of thoracic radiotherapy and chemotherapy is the standard treatment for limited stage disease, while platinum-based chemotherapy is the most effective choice for extensive stage disease. Unfortunately, whatever chemotherapy is used, the results are disappointing. No regimen has proved to be effective in the long run, indeed small cell lung cancer rapidly progresses after a frequent initial strong response, and the mortality rate remains still high. The advent of immunotherapy is actually changing the landscape in oncology. As well as in other cancers, recent trials have demonstrated the efficacy of the combination of immune checkpoint inhibitors and chemotherapy, opening new perspectives for the future of our patients.
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Affiliation(s)
- Andrea Luciani
- Unit of Medical Oncology, San Paolo Hospital, Milan, Italy -
| | - Miriam Blasi
- Unit of Medical Oncology, San Paolo Hospital, Milan, Italy
| | | | - Sabrina Zonato
- Unit of Medical Oncology, San Paolo Hospital, Milan, Italy
| | - Daris Ferrari
- Unit of Medical Oncology, San Paolo Hospital, Milan, Italy
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12
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Ge T, Zhu S, Sun L, Yin L, Dai J, Qian J, Chen X, Zhang P, Zhu J, Jiang G. Development and validation of nomogram prognostic model for early-stage T1-2N0M0 small cell lung cancer: A population-based analysis. Front Oncol 2022; 12:921365. [PMID: 36465408 PMCID: PMC9713004 DOI: 10.3389/fonc.2022.921365] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2022] [Accepted: 10/31/2022] [Indexed: 10/25/2023] Open
Abstract
Background Survival outcomes of early-stage T1-2N0M0 small cell lung cancer (SCLC) patients differ widely, and the existing Veterans Administration Lung Study Group (VALSG) or TNM staging system is inefficient at predicting individual prognoses. In our study, we developed and validated nomograms for individually predicting overall survival (OS) and lung cancer-specific survival (LCSS) in this special subset of patients. Methods Data on patients diagnosed with T1-2N0M0 SCLC between 2000 and 2015 were extracted from the Surveillance, Epidemiology, and End Results (SEER) database. All enrolled patients were split into a training cohort and a validation cohort according to the year of diagnosis. Using multivariable Cox regression, significant prognostic factors were identified and integrated to develop nomograms for 1-, 3-, and 5-year OS and LCSS prediction. The prognostic performance of our new model was measured by the concordance index (C-index) and calibration curve. We compared our latest model and the 8th AJCC staging system using decision curve analyses (DCA). Kaplan-Meier survival analyses were applied to test the application of the risk stratification system. Results A total of 1,147 patients diagnosed from 2000 to 2011 were assigned to the training cohort, and 498 cases that were diagnosed from 2012 to 2015 comprised the validation cohort. Age, surgery, lymph node removal (LNR), and chemotherapy were independent predictors of LCSS. The variables of sex, age, surgery, LNR, and chemotherapy were identified as independent predictors of OS. The above-mentioned prognostic factors were entered into the nomogram construction of OS and LCSS. The C-index of this model in the training cohort was 0.663, 0.702, 0.733, and 0.658, 0.702, 0.733 for predicting 1-, 3-, and 5-year OS and LCSS, respectively. Additionally, in the validation cohort, there were 0.706, 0.707, 0.718 and 0.712, 0.691, 0.692. The calibration curve showed accepted prediction accuracy between nomogram-predicted survival and actual observed survival, regardless of OS or LCSS. In addition, there were significant distinctions in the survival curves of OS and LCSS between different risk groups stratified by prognostic scores. Compared with the 8th AJCC staging system, our new model also improved net benefits. Conclusions We developed and validated novel nomograms for individual prediction of OS and LCSS, integrating the characteristics of patients and tumors. The model showed superior reliability and may help clinicians make treatment strategies and survival predictions for early-stage T1-2N0M0 SCLC patients.
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Affiliation(s)
- Tao Ge
- Department of Thoracic Surgery, Shanghai Pulmonary Hospital, Tongji University School of Medicine, Shanghai, China
| | - Shuncang Zhu
- Department of Thoracic Surgery, Shanghai Pulmonary Hospital, Tongji University School of Medicine, Shanghai, China
| | - Liangdong Sun
- Department of Thoracic Surgery, Shanghai Pulmonary Hospital, Tongji University School of Medicine, Shanghai, China
| | - Laibo Yin
- Department of Thoracic and Cardiovascular Surgery, The First Affiliated Hospital, School of Medicine, Shihezi University, Shihezi, China
| | - Jie Dai
- Department of Thoracic Surgery, Shanghai Pulmonary Hospital, Tongji University School of Medicine, Shanghai, China
| | - Jiayi Qian
- Department of Thoracic Surgery, Shanghai Pulmonary Hospital, Tongji University School of Medicine, Shanghai, China
| | - Xiangru Chen
- Department of Thoracic Surgery, Shanghai Pulmonary Hospital, Tongji University School of Medicine, Shanghai, China
| | - Peng Zhang
- Department of Thoracic Surgery, Shanghai Pulmonary Hospital, Tongji University School of Medicine, Shanghai, China
| | - Jialong Zhu
- Department of Thoracic and Cardiovascular Surgery, The First Affiliated Hospital, School of Medicine, Shihezi University, Shihezi, China
| | - Gening Jiang
- Department of Thoracic Surgery, Shanghai Pulmonary Hospital, Tongji University School of Medicine, Shanghai, China
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13
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Go SI, Park S, Kang MH, Kim HG, Kang JH, Kim JH, Lee GW. Endothelial activation and stress index (EASIX) as a predictive biomarker in small cell lung cancer. Cancer Biomark 2022; 35:217-225. [PMID: 36120771 DOI: 10.3233/cbm-220032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Endothelial activation and insult may contribute to the aggressive clinical course of small-cell lung cancer (SCLC); however, no predictive biomarker for this pathogenesis has been identified. OBJECTIVE To evaluate the clinical impact of the endothelial activation and stress index (EASIX) in SCLC. METHODS In this retrospective study, the EASIX was calculated from measurements of serum lactate dehydrogenase, creatinine, and platelet levels. A total of 264 patients with SCLC treated with platinum-based chemotherapy were stratified into high and low EASIX groups. RESULTS Complete and objective response rates in the limited-stage (LD) were 19.5% vs. 33.3% (P= 0.050) and 85.4% vs. 97.9% (P= 0.028) in the high and low EASIX groups, respectively. There was no significant difference in the response rate between the two groups in the extensive-stage (ED). The median overall survival was 9.8 vs. 40.5 months in LD (P< 0.001) and 7.2 vs. 11.9 months in ED (P< 0.001) in the high and low EASIX groups, respectively. In multivariate analyses, a high EASIX level was an independent prognostic factor for worse progression-free and overall survival irrespective of stage. CONCLUSION EASIX may be a potential predictive biomarker of SCLC.
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Affiliation(s)
- Se-Il Go
- Division of Hematology-Oncology, Department of Internal Medicine, Institute of Health Science, Gyeongsang National University Changwon Hospital, Gyeongsang National University College of Medicine, Changwon, Korea
| | - Sungwoo Park
- Division of Hematology-Oncology, Department of Internal Medicine, Institute of Health Science, Gyeongsang National University Hospital, Gyeongsang National University College of Medicine, Jinju, Korea
| | - Myoung Hee Kang
- Division of Hematology-Oncology, Department of Internal Medicine, Institute of Health Science, Gyeongsang National University Changwon Hospital, Gyeongsang National University College of Medicine, Changwon, Korea
| | - Hoon-Gu Kim
- Division of Hematology-Oncology, Department of Internal Medicine, Institute of Health Science, Gyeongsang National University Changwon Hospital, Gyeongsang National University College of Medicine, Changwon, Korea
| | - Jung Hun Kang
- Division of Hematology-Oncology, Department of Internal Medicine, Institute of Health Science, Gyeongsang National University Hospital, Gyeongsang National University College of Medicine, Jinju, Korea
| | - Jung Hoon Kim
- Division of Hematology-Oncology, Department of Internal Medicine, Institute of Health Science, Gyeongsang National University Hospital, Gyeongsang National University College of Medicine, Jinju, Korea
| | - Gyeong-Won Lee
- Division of Hematology-Oncology, Department of Internal Medicine, Institute of Health Science, Gyeongsang National University Hospital, Gyeongsang National University College of Medicine, Jinju, Korea
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14
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Çimen F, Aloglu M, Düzgün S, Şentürk A, Atikcan Ş, Özmen Ö. What is the effect of tumor diameter, lymph node metastases, and SUVmax value on prognosis in limited-stage small cell lung cancer? Rev Assoc Med Bras (1992) 2022; 68:1252-1258. [PMID: 36228257 PMCID: PMC9575018 DOI: 10.1590/1806-9282.20220325] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2022] [Accepted: 06/17/2022] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVE This study was designed to investigate the link between survival and prognostic factors such as tumor size, lymph node metastasis, and metabolic activity detected on positron emission tomography/computed tomography in patients with limited-stage small cell lung carcinoma. METHODS Patients who were admitted to our hospital with pathological diagnosis of limited-stage small cell lung cancer between January 2015 and December 2019 and were older than 18 years were retrospectively screened. RESULTS A total of 77 patients, including 10 females and 67 males, were included in the study. While there were 39 patients over 60 years of age, 38 patients were under 60.The ratios of male patients, N stage, multiple lymph nodes, distant metastasis, brain metastasis, and prophylactic cranial irradiation in the deceased patients' group were significantly (p=0.008, p=0.000, p=0.000, p=0.000, p=0.013, p=0.000, respectively) higher than those in the living patients' group.In the univariate model, we observed that gender, smoking, T stage, N stage, multiple lymph nodes, distant metastasis, brain metastasis, liver metastasis, sequential chemotherapy, sequential radiotherapy, concurrent chemoradiotherapy, and prophylactic cranial irradiation had significant effect (p=0.049, p=0.021, p=0.022, p=0.000, p=0.000, p=0.000 p=0.003, p=0.037, p=0.029, p=0.049, p=0.000, respectively) on survival time. In the multivariate model, smoking, N stage, liver metastasis, and prophylactic cranial irradiation demonstrated significant independent effect (p=0.010, p=0.003, p=0.004, p=0.000, respectively) on survival time. CONCLUSION Our findings provide useful information for better patient management, especially in terms of negative factors on the continuation of survival during and after the treatment of limited-stage small cell lung carcinoma patients.
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Affiliation(s)
- Filiz Çimen
- Ankara University, Faculty of Health Sciences, Ataturk Chest Diseases and Thoracic Surgery Training and Research Hospital, Chest Disease Department – Ankara, Turkish.,Corresponding author:
| | - Melike Aloglu
- Ankara University, Faculty of Health Sciences, Ataturk Chest Diseases and Thoracic Surgery Training and Research Hospital, Chest Disease Department – Ankara, Turkish
| | - Sevim Düzgün
- Ankara University, Faculty of Health Sciences, Ataturk Chest Diseases and Thoracic Surgery Training and Research Hospital, Chest Disease Department – Ankara, Turkish
| | - Ayşegül Şentürk
- Ankara University, Faculty of Health Sciences, Ataturk Chest Diseases and Thoracic Surgery Training and Research Hospital, Chest Disease Department – Ankara, Turkish
| | - Şükran Atikcan
- Ankara University, Faculty of Health Sciences, Ataturk Chest Diseases and Thoracic Surgery Training and Research Hospital, Chest Disease Department – Ankara, Turkish
| | - Özlem Özmen
- Ankara University, Faculty of Health Sciences, Ataturk Chest Diseases and Thoracic Surgery Training and Research Hospital, Nuclear Medicine Department – Ankara, Turkish
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15
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Stratmann JA, Timalsina R, Atmaca A, Rosery V, Frost N, Alt J, Waller CF, Reinmuth N, Rohde G, Saalfeld FC, von Rose AB, Acker F, Aspacher L, Möller M, Sebastian M. Clinical predictors of survival in patients with relapsed/refractory small-cell lung cancer treated with checkpoint inhibitors: a German multicentric real-world analysis. Ther Adv Med Oncol 2022; 14:17588359221097191. [PMID: 35677321 PMCID: PMC9168937 DOI: 10.1177/17588359221097191] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2021] [Accepted: 04/11/2022] [Indexed: 01/22/2023] Open
Abstract
Objectives: Small-cell lung cancer (SCLC) is a lung malignancy with high relapse rates
and poor survival outcomes. Treatment-resistant disease relapse occurs
frequently and effective salvage therapies are urgently needed. Materials and Methods: We aimed to define efficacy and safety of checkpoint inhibitors (CPIs) in a
heterogeneous population of relapsed and refractory SCLC patients in a large
retrospective multicentric real-world cohort across German tertiary care
centers. Results: A total of 111 patients from 11 treatment centers were included. Median age
of all patients was 64 years, and 63% were male. Approximately one-third of
all patients had poor performance status [Eastern Cooperative Oncology Group
(ECOG) ⩾ 2], and 37% had known brain metastases. Patients were heavily
pretreated with a median number of prior therapy lines of 2 (range, 1–8).
Median follow-up of the entire cohort was 21.7 months. Nivolumab and
Nivolumab/Ipilimumab were the most common regimens. Overall disease control
rate was 27.2% in all patients and was numerically higher in CPI combination
regimens compared with single-agent CPI (31.8% versus
23.8%; p = 0.16). Median overall survival (OS) was
5.8 months [95% confidence interval (CI), 1.7–9.9 months]. The 12- and
24-month survival rates were 31.8% and 12.7%, respectively. The 12-week
death rate was 27.9%. Disease control and response rate were significantly
lower in patients with liver metastases. Platinum sensitivity (to first-line
treatment), metastatic burden, and lactate dehydrogenase (LDH) showed
prognostic impact on survival in univariate analysis.
Neutrophil-to-lymphocyte ratio (NLR) was a significant and independent
predictor of survival in univariate (p = 0.01) and
multivariate analyses [hazard ratio (HR), 2.1; 95% CI = 1.1–4.1;
p = 0.03]. Conclusion: CPI in patients with relapsed or refractory (R/R) SCLC is of limited value in
an overall patient cohort; however, long-term survival, in particular with
CPI combination strategies, is possible. Clinical characteristics allow a
more differentiated subgroup selection, in particular patients with low NLR
showed less benefit from CPI in R/R SCLC.
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Affiliation(s)
- Jan A. Stratmann
- Department of Internal Medicine, Hematology/Oncology, Goethe University, Theodor Stern Kai 7, 60596 Frankfurt am Main, Germany
| | - Radha Timalsina
- Department of Internal Medicine, Hematology/Oncology, Goethe University, Frankfurt, Germany
| | - Akin Atmaca
- Department of Oncology and Hematology, Krankenhaus Nordwest, UCT-University Cancer Center, Frankfurt, Germany
| | - Vivian Rosery
- Department of Medical Oncology, West German Cancer Center, University Medicine Essen, Essen, Germany
| | - Nikolaj Frost
- Charité – Universitätsmedizin Berlin, Berlin, GermanyHumboldt-Universität zu Berlin, Berlin, Germany
- Department of Infectious Diseases and Pulmonary Medicine, Berlin Institute of Health, Berlin, Germany
| | - Jürgen Alt
- Department of Internal Medicine III (Hematology, Oncology, Pneumology), University Medical Center Mainz, Mainz, Germany
| | - Cornelius F. Waller
- Internal Medicine I, Haematology, Oncology and Stem Cell Transplantation, Faculty of Medicine, Freiburg University Medical Center, Freiburg, Germany
| | - Niels Reinmuth
- Department of Oncology, Asklepios Clinic München-Gauting, Gauting, Germany
| | - Gernot Rohde
- Department of Respiratory Medicine, Medical Clinic 1, University Hospital, Frankfurt, Germany
| | - Felix C. Saalfeld
- Department for Internal Medicine I, University Hospital Carl Gustav Carus Dresden, TU Dresden, Dresden, Germany
| | - Aaron Becker von Rose
- Department of Internal Medicine III, Klinikum rechts der Isar, Technical University Munich, Munich, Germany
| | - Fabian Acker
- Department of Internal Medicine, Hematology/Oncology, Goethe University, Frankfurt, Germany
| | - Lukas Aspacher
- Department of Internal Medicine, Hematology/Oncology, Goethe University, Frankfurt, Germany
| | - Miriam Möller
- Department of Oncology, Martha–Maria Hospital Halle, Halle, Germany
| | - Martin Sebastian
- Department of Internal Medicine, Hematology/Oncology, Goethe University, Frankfurt, Germany
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Li XY, Rao Y, Sun B, Mao XM. Efficacy and Safety of Anlotinib Combined with PD-1 Blockades for Patients with Previously Treated Epithelial Ovarian Cancer: A Retrospective Study. Int J Gen Med 2022; 15:3977-3989. [PMID: 35440872 PMCID: PMC9013415 DOI: 10.2147/ijgm.s352536] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2021] [Accepted: 02/23/2022] [Indexed: 12/24/2022] Open
Abstract
Purpose This study was to investigate the efficacy and safety of anlotinib combined with programmed cell death protein 1 (PD-1) blockades for patients with previously treated advanced epithelial ovarian cancer (EOC). Patients and Methods Present study was designed as a retrospective study, a total of 32 patients with advanced EOC who progressed after at least two lines previously available standard therapy were included in this study. All the patients were administered with anlotinib combined with PD-1 blockades administration. Clinical activity was implemented and analyzed, which was assessed according to the change of target lesion by imaging evidence and all the subjects were followed up regularly. Safety profile were collected and documented during the treatment. Univariate analysis was carried out using log rank test and multivariate analysis were adjusted by Cox regression analysis. Results The best overall response suggested that partial response was noted in 12 patients, stable disease was observed in 14 patients, progressive disease was found in 6 patients. Therefore, the objective response rate (ORR) of the 32 patients was 37.5% (95% CI: 21.1–56.3%), disease control rate (DCR) of the patients was 81.3% (95% CI: 63.6–92.8%). The median follow-up duration of this study was 17.5 months (follow-up range: 0.9–33.5 months). And the median PFS and OS of the 32-patient cohort was 6.8 months (95% CI: 2.64–10.96) and 18.5 months (95% CI: 14.08–22.92), respectively. The most common treatment-related adverse reactions were fatigue (68.8%), nausea and vomiting (56.3%), hypertension (50.0%) and diarrhea (40.6%). Multivariate Cox regression analysis for PFS indicated that ECOG performance status and FIGO stage were independent factors to predict PFS of patients with previously treated EOC. Conclusion Anlotinib combined with PD-1 blockades demonstrated promising efficacy and tolerable safety profile for patients with previously treated advanced EOC preliminarily. The conclusion should be confirmed in more patients with advanced EOC subsequently.
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Affiliation(s)
- Xiao-Yuan Li
- Department of Medical Oncology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, 100730, People’s Republic of China
| | - Yang Rao
- Department of Gynecological Oncology, Tianjin Central Obstetrics and Gynecology Hospital, Tianjin, 300199, People’s Republic of China
| | - Bing Sun
- Department of Radiation Oncology, The Fifth Medical Center, Chinese PLA General Hospital, Beijing, 100071, People’s Republic of China
| | - Xue-Mei Mao
- Department of Obstetrics and Gynecology, Tianjin Integrated Traditional Chinese and Western Medicine Hospital (Nankai Hospital), Tianjin, 300102, People’s Republic of China
- Correspondence: Xue-Mei Mao; Bing Sun, Tel +86 13820312420; +86 13810193881, Email ;
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Li Y, Sun Z, Sun W, Wang H, Zu J. Effectiveness and Safety of Anlotinib Monotherapy for Patients with Extensive-stage Small-Cell Lung Cancer Who Progressed to Chemotherapy: A Real-world Exploratory Study. Clin Med Insights Oncol 2022; 16:11795549211067184. [PMID: 35095286 PMCID: PMC8793436 DOI: 10.1177/11795549211067184] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2021] [Accepted: 11/29/2021] [Indexed: 12/25/2022] Open
Abstract
Background: Anlotinib demonstrated promising efficacy for patients with extensive-stage small-cell lung cancer (ES-SCLC) in clinical trials. However, the real-world evidence of anlotinib monotherapy in ES-SCLC was still limited currently. Therefore, present study was to investigate the effectiveness and safety of anlotinib for patients with ES-SCLC who progressed to chemotherapy in real-world and the potential biomarker during anlotinib monotherapy. Methods: A total of 89 patients with ES-SCLC who failed the previous chemotherapy treatment were recruited. All the patients were administered with anlotinib monotherapy. Demographic data of the patients were collected; effectiveness and safety profile during anlotinib monotherapy were documented through electronic medical record system in the hospital. Progression-free survival (PFS) and overall survival (OS) were presented using Kaplan-Meier survival curves and multivariate analysis was adjusted by Cox regression analysis. Results: All the 89 patients with ES-SCLC who progressed to chemotherapy were available for the assessment of effectiveness and safety profile. Best overall response indicated that partial response was observed in 6 patients (6.7%), stable disease was noted in 61 patients (68.5%), and progressive disease was found in 22 patients (24.7%). Therefore, the objective response rate (ORR) and disease control rate (DCR) of the 89 patients with ES-SCLC was 6.7% (95% confidence interval [CI]: 2.5%-14.1%) and 75.3% (95% CI: 65.0%-83.8%), respectively. The prognostic data suggested that the median PFS of the 89 patients was 3.1 months (95% CI: 2.10-4.10), and the median OS was 8.6 months (95% CI: 7.42-9.78). In addition, the most common adverse reactions of the patients who received anlotinib monotherapy were hypertension (34.8%), hand-foot syndrome (30.3%), fatigue (29.2%), loss of appetite (27.0%), and hematological toxicity (21.3%). Association analysis between biomarker (hypertension status) and prognosis indicated that the median PFS of patients with hypertension and patients with non-hypertension was 5.5 and 3.0 months, respectively (χ2 = 4.64, P = .031). Furthermore, multivariate Cox analysis for PFS suggested that hypertension status was an independent factor for PFS (hazard ratio [HR] = 0.71, P = .035]. Conclusion: Anlotinib monotherapy showed encouraging effectiveness and acceptable safety profile for patients with ES-SCLC in real world. Hypertension induced by anlotinib administration might be used as a potential biomarker to predict superior PFS for patients with ES-SCLC.
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Affiliation(s)
- Yonghui Li
- Department of Thoracic Surgery, Affiliated Hospital of Hebei University, Baoding, China
| | - Zhenqing Sun
- Department of Thoracic Surgery, Affiliated Hospital of Hebei University, Baoding, China
| | - Wei Sun
- Department of Oncology, Lixian County Hospital, Baoding, China
| | - Haibo Wang
- Department of Thoracic Surgery, Affiliated Hospital of Hebei University, Baoding, China
| | - Jinchi Zu
- Department of Thoracic Surgery, Affiliated Hospital of Hebei University, Baoding, China
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The effect of performance score, prognostic nutritional index, serum neutrophil-to-lymphocyte ratio, and thrombocyte-to-lymphocyte ratio on prognosis in non-small cell lung cancer. MARMARA MEDICAL JOURNAL 2022. [DOI: 10.5472/marumj.1065820] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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19
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The effect of performance score, prognostic nutritional index, serum neutrophil-to-lymphocyte ratio, and thrombocyte-to-lymphocyte ratio on prognosis in non-small cell lung cancer. MARMARA MEDICAL JOURNAL 2022. [DOI: 10.5472/marumj.1061206] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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20
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Hao YY, Qiao YP, Cheng JD. Clinical Activity and Safety of Anlotinib Combined with PD-1 Blockades for Patients with Previously Treated Small Cell Lung Cancer. Int J Gen Med 2022; 14:10483-10493. [PMID: 35002304 PMCID: PMC8722563 DOI: 10.2147/ijgm.s337316] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2021] [Accepted: 10/19/2021] [Indexed: 12/27/2022] Open
Abstract
Objective Anlotinib was the standard monotherapy for patients with previously treated small cell lung cancer (SCLC) in recent years. Programmed cell death protein 1 (PD-1) blockade combined with antiangiogenic targeted drugs have proved to play a synergistic action for cancer treatment clinically. Consequently, the present study was to investigate the efficacy and safety of anlotinib combined with PD-1 blockades for patients with previously treated SCLC. Methods A total of 36 patients with SCLC who were treated with at least one previous systemic chemotherapy regimen participated in this study retrospectively. All the patients were administered with anlotinib plus PD-1 blockades therapy. Clinical activity was assessed according to the change of target lesion by imaging evidence and all the subjects were followed up regularly. Safety profiles were collected and documented during the treatment. Univariate analysis was carried out using Log rank test and multivariate analysis was adjusted by Cox regression analysis. Results All the 36 patients with previously treated SCLC were able to have their efficacy and safety profile evaluated. The best overall response of the combination regimen showed that complete response was observed in one patient, partial response was noted in 9 patients, stable disease was reported in 19 patients, progressive disease was seen in 7 patients. Therefore, the objective response rate (ORR) of the 36 patients was 27.8% (95% CI: 14.2-45.2%), disease control rate (DCR) was 80.6% (95% CI: 64.0-91.8%). Regarding the prognostic data, the median PFS and OS of the 36 patients was 4.6 months (95% CI: 3.13-6.07) and 9.3 months (95% CI: 3.30-15.30), respectively. The most common treatment-related adverse reactions were hypertension (52.8%), fatigue (47.2%), diarrhea (38.9%), hand and foot reaction (38.9%) and dermal toxicity (33.3%). Furthermore, multivariate Cox regression analysis for PFS indicated that ECOG performance status was an independent factor to predict PFS. Conclusion Anlotinib combined with PD-1 blockades regimen preliminarily demonstrated encouraging efficacy and tolerable safety for patients with previously treated SCLC. The conclusion should be validated in prospective clinical trials subsequently.
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Affiliation(s)
- Yan-Yan Hao
- Department of Respiratory and Critical Care Medicine, Shanxi Bethune Hospital, Shanxi Academy of Medical Sciences, Tongji Shanxi Hospital, Third Hospital of Shanxi Medical University, Taiyuan, 030032, Shanxi, People's Republic of China.,Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, Hubei, People's Republic of China
| | - Yi-Peng Qiao
- Department of Internal Medicine, Qing-Xu County People's Hospital, Taiyuan, 030499, Shanxi, People's Republic of China
| | - Jian-De Cheng
- Department of Respiratory and Critical Care Medicine, Shanxi Bethune Hospital, Shanxi Academy of Medical Sciences, Tongji Shanxi Hospital, Third Hospital of Shanxi Medical University, Taiyuan, 030032, Shanxi, People's Republic of China.,Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, Hubei, People's Republic of China
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21
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Debieuvre D, Dayen C, Dixmier A, Pau D, Sibley-Revelat A, Greenwood W, Gally S, Falchero L. FRESC: French Real world Extensive stage SCLC Cohorts: A retrospective study on patient characteristics and treatment strategy based on KBP-2010. Lung Cancer 2021; 164:1-7. [PMID: 34954472 DOI: 10.1016/j.lungcan.2021.11.013] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2021] [Revised: 11/12/2021] [Accepted: 11/22/2021] [Indexed: 11/25/2022]
Abstract
OBJECTIVES FRESC reanalyzed extensive-stage small-cell lung cancer (ES-SCLC) patient data from the French KBP-2010 cohort to describe the characteristics and therapeutic management of ES-SCLC and provide real-world estimates of survival. METHODS A target population of first line (1L) ES-SCLC was identified at initial diagnosis in KBP-2010 (KBP population, N = 796). A KBP-2010 subpopulation was defined as patients who also met the IMpower133 clinicaltrial PS ≤ 1 inclusion criteria (KBP-PS_0/1 population, N = 394). Subgroups were defined according to the 1L ES-SCLC chemotherapy regimens: carboplatin or cisplatin with etoposide (Carb-E or Cisp-E subgroups). RESULTS The vast majority of KBP populations exhibited stage IV ES-SCLC (84.9%) at initial diagnosis. Median age was 66 years; patients were mostly male and smokers. Patients receiving Cisp + Eto were younger (median age 61 years [55.0-67.0]) and fitter (25.5% had PS ≥ 2) than those receiving Carb + Eto (71 years [62.5-77.5]; 44.1%had PS ≥ 2). Median overall survival (OS) of chemotherapy-treated 1L ES-SCLC patients varied from 7.0 months [95% CI, 6.1; 7.8] in the KBPCarb-Esubgroups to 9.6 months [95% CI, 8.4;10.8] in the KBP Cisp-E subgroup. KBP-PS_0/1 population showed better median OS, especially for the Cisp-E subgroup (10 months [95% CI, 8.7; 11.3]). CONCLUSION In the KBP-PS_0/1 population, median OS was close to the one that was found in the IMpower133 control arm. Although this needs to be confirmed by further research, it suggests the transposability of the IMpower133 results to real-life conditions.
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Affiliation(s)
| | | | | | - David Pau
- Roche SAS, Boulogne-Billancourt, France
| | | | | | | | - Lionel Falchero
- Hôpital Nord-Ouest, Pneumologie, Villefranche-sur-Saône, France
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22
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Ganti AKP, Loo BW, Bassetti M, Blakely C, Chiang A, D'Amico TA, D'Avella C, Dowlati A, Downey RJ, Edelman M, Florsheim C, Gold KA, Goldman JW, Grecula JC, Hann C, Iams W, Iyengar P, Kelly K, Khalil M, Koczywas M, Merritt RE, Mohindra N, Molina J, Moran C, Pokharel S, Puri S, Qin A, Rusthoven C, Sands J, Santana-Davila R, Shafique M, Waqar SN, Gregory KM, Hughes M. Small Cell Lung Cancer, Version 2.2022, NCCN Clinical Practice Guidelines in Oncology. J Natl Compr Canc Netw 2021; 19:1441-1464. [PMID: 34902832 DOI: 10.6004/jnccn.2021.0058] [Citation(s) in RCA: 175] [Impact Index Per Article: 58.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
The NCCN Clinical Practice Guidelines in Oncology (NCCN Guidelines) for Small Cell Lung Cancer (SCLC) provide recommended management for patients with SCLC, including diagnosis, primary treatment, surveillance for relapse, and subsequent treatment. This selection for the journal focuses on metastatic (known as extensive-stage) SCLC, which is more common than limited-stage SCLC. Systemic therapy alone can palliate symptoms and prolong survival in most patients with extensive-stage disease. Smoking cessation counseling and intervention should be strongly promoted in patients with SCLC and other high-grade neuroendocrine carcinomas. The "Summary of the Guidelines Updates" section in the SCLC algorithm outlines the most recent revisions for the 2022 update, which are described in greater detail in this revised Discussion text.
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Affiliation(s)
| | | | | | | | | | | | | | - Afshin Dowlati
- Case Comprehensive Cancer Center/University Hospitals Seidman Cancer Center and Cleveland Clinic Taussig Cancer Institute
| | | | | | | | | | | | - John C Grecula
- The Ohio State University Comprehensive Cancer Center - James Cancer Hospital and Solove Research Institute
| | - Christine Hann
- The Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins
| | | | | | | | | | | | - Robert E Merritt
- The Ohio State University Comprehensive Cancer Center - James Cancer Hospital and Solove Research Institute
| | - Nisha Mohindra
- Robert H. Lurie Comprehensive Cancer Center of Northwestern University
| | | | - Cesar Moran
- The University of Texas MD Anderson Cancer Center
| | | | - Sonam Puri
- Huntsman Cancer Institute at the University of Utah
| | - Angel Qin
- University of Michigan Rogel Cancer Center
| | | | - Jacob Sands
- Dana Farber/Brigham and Women's Cancer Center
| | | | | | - Saiama N Waqar
- Siteman Cancer Center at Barnes-Jewish Hospital and Washington University School of Medicine
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Safety and efficacy of ICI plus anlotinib vs. anlotinib alone as third-line treatment in extensive-stage small cell lung cancer: a retrospective study. J Cancer Res Clin Oncol 2021; 148:401-408. [PMID: 34797416 PMCID: PMC8800903 DOI: 10.1007/s00432-021-03858-2] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2021] [Accepted: 11/11/2021] [Indexed: 11/01/2022]
Abstract
PURPOSE The objective of this study was to evaluate the safety and efficacy of immune checkpoint inhibitor (ICI) plus anlotinib as third-line treatment in extensive-stage small cell lung cancer (ES-SCLC). METHODS A total of 120 patients with ES-SCLC who were admitted to Shandong Cancer Hospital between January 2019 and December 2020 were retrospectively analyzed. They were divided into the observation group (n = 62) and the control group (n = 58) according to their different treatment plans. The observation group was given ICI plus anlotinib, while the control group was given anlotinib alone. The primary endpoint of the study was progression-free survival (PFS), and the secondary endpoints were the objective response rate (ORR) and disease control rate (DCR). An efficacy evaluation was carried out every 6 weeks. Univariate and multivariate analyses were performed to identify the prognostic factors. The main treatment-related adverse events were evaluated according to the Common Terminology Criteria for Adverse Events version 5.0. RESULTS In the observation group and the control group, the DCRs were 87.1% and 72.4% (p = 0.044), and the ORRs were 19.4% and 6.9% (p = 0.045), respectively. The median PFS was longer in the observation group (7.5 months) than in the control group (4.6 months) (p = 0.0033). In Cox regression analysis, the Eastern Cooperative Oncology Group performance status score, brain metastases and metastatic sites were prognostic factors of ICI plus anlotinib. Compared with the control group, grade 1-2 immune-related pneumonia and hypothyroidism of patients in the observation group were significantly increased (p < 0.05), but grade 3-4 treatment-related adverse reactions were not significantly increased (p > 0.05). CONCLUSION ICI plus anlotinib showed promising efficacy and manageable toxicity in third-line treatment of ES-SCLC.
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Das M, Padda SK, Weiss J, Owonikoko TK. Advances in Treatment of Recurrent Small Cell Lung Cancer (SCLC): Insights for Optimizing Patient Outcomes from an Expert Roundtable Discussion. Adv Ther 2021; 38:5431-5451. [PMID: 34564806 PMCID: PMC8475485 DOI: 10.1007/s12325-021-01909-1] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2021] [Accepted: 08/25/2021] [Indexed: 10/31/2022]
Abstract
Second-line treatment options for patients with relapsed, extensive-stage small cell lung cancer (ES-SCLC) are limited, and even with currently available treatments, prognosis remains poor. Until recently, topotecan (a topoisomerase I inhibitor) was the only drug approved by the United States (US) Food and Drug Administration (FDA) for the management of ES-SCLC following progression after first-line treatment with etoposide plus a platinum derivative (EP; carboplatin preferred). With the most recent approval of EP plus a programmed death ligand 1 (PD-L1) inhibitor, there are now more therapeutic options for managing ES-SCLC. A number of novel agents have emerging data for activity in relapsed ES-SCLC, and single-agent lurbinectedin (an alkylating drug and selective inhibitor of oncogenic transcription and DNA repair machinery in tumor cells) has conditional FDA approval for use in this patient population. Trilaciclib, a short-acting cyclin-dependent kinase 4/6 (CDK 4/6) inhibitor, has also been recently approved as a supportive intervention for use prior to an EP or a topotecan-containing regimen to diminish the incidence of chemotherapy-induced myelosuppression. The current review is based on a recent expert roundtable discussion and summarizes current therapeutic agents and emerging data on newer agents and biomarkers. It also provides evidence-based clinical considerations and a treatment decision tool for oncologists treating patients with relapsed ES-SCLC. This paper discusses the importance of various factors to consider when selecting a second-line treatment option, including prior first-line treatment, available second-line treatment options, tumor platinum sensitivity, and patient characteristics (such as performance status, comorbidities, and patient-expressed and perceived values).
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25
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Doshita K, Kenmotsu H, Omori S, Tabuchi Y, Kawabata T, Kodama H, Nishioka N, Miyawaki E, Iida Y, Miyawaki T, Mamesaya N, Kobayashi H, Ko R, Wakuda K, Ono A, Naito T, Murakami H, Mori K, Harada H, Kaneko T, Takahashi T. Long-term survival data of patients with limited disease small cell lung cancer: a retrospective analysis. Invest New Drugs 2021; 40:411-419. [PMID: 34716848 DOI: 10.1007/s10637-021-01183-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2021] [Accepted: 09/16/2021] [Indexed: 12/24/2022]
Abstract
INTRODUCTION In patients with limited disease small cell lung cancer (LD-SCLC) treated with concurrent chemoradiotherapy (CCRT), long-term survival data have not been fully evaluated. Moreover, the association between long-term prognosis and prognostic factors has not been sufficiently investigated. METHODS In this retrospective study, we evaluated the efficacy of CCRT in 120 patients with LD-SCLC with a plan for curative CRT using concurrent accelerated hyperfractionated radiotherapy. RESULTS The patients had a median age of 65.5 years, predominantly male (73%), and had clinical stage III disease (80%). The median follow-up time for overall survival (OS) was 72.2 months, median OS was 42.5 months, and the 3-year and 5-year survival rates were 52.4% and 41.8%, respectively. The median progression-free survival (PFS) was 12.5 months, and the 3-year and 5-year PFS rates were 37.6% and 33.6%, respectively. The 5-year OS rates of patients who achieved PFS at each time point were 70.9%, 83.6%, and 91.9% at 12, 24, and 36 months, respectively. The gradual increase in the 5-year OS rate following PFS extension and initial depression of the Kaplan-Meier curve showed disease progression frequently occurred in the first 2 years after initiation of CCRT. The Cox proportional hazards model showed no significant factors correlated with long-term survival through univariate and multivariate analyses. Although the prognostic factors associated with long-term prognosis in LD-SCLC were not identified, the 5-year survival rate was 41.8%, and among patients without disease progression at 2 years, the 5-year survival rate was 83.6%. CONCLUSION These data suggested that the prognosis of patients with LD-SCLC was improving.
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Affiliation(s)
- Kosei Doshita
- Division of Thoracic Oncology, Shizuoka Cancer Center, Nagaizumi-Sho Sunto-Gun, Shimonagakubo Shizuoka, 1007411-8777, Japan.,Department of Pulmonology, Yokohama City University Graduate School of Medicine, 3-9 Fukuura, Kanazawa-ku, Yokohama, Kanagawa, 236-0004, Japan
| | - Hirotsugu Kenmotsu
- Division of Thoracic Oncology, Shizuoka Cancer Center, Nagaizumi-Sho Sunto-Gun, Shimonagakubo Shizuoka, 1007411-8777, Japan.
| | - Shota Omori
- Division of Thoracic Oncology, Shizuoka Cancer Center, Nagaizumi-Sho Sunto-Gun, Shimonagakubo Shizuoka, 1007411-8777, Japan
| | - Yuya Tabuchi
- Radiation and Proton Therapy Center, Shizuoka Cancer Center, 1007 Shimonagakubo, Nagaizumi-cho, Suntou-gun, Shizuoka, 411-8777, Japan
| | - Takanori Kawabata
- Clinical Research Center, Shizuoka Cancer Center, Nagaizumi-Cho Sunto-Gun, Shimonagakubo Shizuoka, 1007411-8777, Japan
| | - Hiroaki Kodama
- Division of Thoracic Oncology, Shizuoka Cancer Center, Nagaizumi-Sho Sunto-Gun, Shimonagakubo Shizuoka, 1007411-8777, Japan
| | - Naoya Nishioka
- Division of Thoracic Oncology, Shizuoka Cancer Center, Nagaizumi-Sho Sunto-Gun, Shimonagakubo Shizuoka, 1007411-8777, Japan
| | - Eriko Miyawaki
- Division of Thoracic Oncology, Shizuoka Cancer Center, Nagaizumi-Sho Sunto-Gun, Shimonagakubo Shizuoka, 1007411-8777, Japan
| | - Yuko Iida
- Division of Thoracic Oncology, Shizuoka Cancer Center, Nagaizumi-Sho Sunto-Gun, Shimonagakubo Shizuoka, 1007411-8777, Japan
| | - Taichi Miyawaki
- Division of Thoracic Oncology, Shizuoka Cancer Center, Nagaizumi-Sho Sunto-Gun, Shimonagakubo Shizuoka, 1007411-8777, Japan
| | - Nobuaki Mamesaya
- Division of Thoracic Oncology, Shizuoka Cancer Center, Nagaizumi-Sho Sunto-Gun, Shimonagakubo Shizuoka, 1007411-8777, Japan
| | - Haruki Kobayashi
- Division of Thoracic Oncology, Shizuoka Cancer Center, Nagaizumi-Sho Sunto-Gun, Shimonagakubo Shizuoka, 1007411-8777, Japan
| | - Ryo Ko
- Division of Thoracic Oncology, Shizuoka Cancer Center, Nagaizumi-Sho Sunto-Gun, Shimonagakubo Shizuoka, 1007411-8777, Japan
| | - Kazushige Wakuda
- Division of Thoracic Oncology, Shizuoka Cancer Center, Nagaizumi-Sho Sunto-Gun, Shimonagakubo Shizuoka, 1007411-8777, Japan
| | - Akira Ono
- Division of Thoracic Oncology, Shizuoka Cancer Center, Nagaizumi-Sho Sunto-Gun, Shimonagakubo Shizuoka, 1007411-8777, Japan
| | - Tateaki Naito
- Division of Thoracic Oncology, Shizuoka Cancer Center, Nagaizumi-Sho Sunto-Gun, Shimonagakubo Shizuoka, 1007411-8777, Japan
| | - Haruyasu Murakami
- Division of Thoracic Oncology, Shizuoka Cancer Center, Nagaizumi-Sho Sunto-Gun, Shimonagakubo Shizuoka, 1007411-8777, Japan
| | - Keita Mori
- Clinical Research Center, Shizuoka Cancer Center, Nagaizumi-Cho Sunto-Gun, Shimonagakubo Shizuoka, 1007411-8777, Japan
| | - Hideyuki Harada
- Radiation and Proton Therapy Center, Shizuoka Cancer Center, 1007 Shimonagakubo, Nagaizumi-cho, Suntou-gun, Shizuoka, 411-8777, Japan
| | - Takeshi Kaneko
- Department of Pulmonology, Yokohama City University Graduate School of Medicine, 3-9 Fukuura, Kanazawa-ku, Yokohama, Kanagawa, 236-0004, Japan
| | - Toshiaki Takahashi
- Division of Thoracic Oncology, Shizuoka Cancer Center, Nagaizumi-Sho Sunto-Gun, Shimonagakubo Shizuoka, 1007411-8777, Japan
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Jain P, Khorrami M, Gupta A, Rajiah P, Bera K, Viswanathan VS, Fu P, Dowlati A, Madabhushi A. Novel Non-Invasive Radiomic Signature on CT Scans Predicts Response to Platinum-Based Chemotherapy and Is Prognostic of Overall Survival in Small Cell Lung Cancer. Front Oncol 2021; 11:744724. [PMID: 34745966 PMCID: PMC8564480 DOI: 10.3389/fonc.2021.744724] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2021] [Accepted: 09/29/2021] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND Small cell lung cancer (SCLC) is an aggressive malignancy characterized by initial chemosensitivity followed by resistance and rapid progression. Presently, there are no predictive biomarkers that can accurately guide the use of systemic therapy in SCLC patients. This study explores the role of radiomic features from both within and around the tumor lesion on pretreatment CT scans to a) prognosticate overall survival (OS) and b) predict response to chemotherapy. METHODS One hundred fifty-three SCLC patients who had received chemotherapy were included. Lung tumors were contoured by an expert reader. The patients were divided randomly into approximately equally sized training (Str = 77) and test sets (Ste = 76). Textural descriptors were extracted from the nodule (intratumoral) and parenchymal regions surrounding the nodule (peritumoral). The clinical endpoints of this study were OS, progression-free survival (PFS), and best objective response to chemotherapy. Patients with complete or partial response were defined as "responders," and those with stable or progression of disease were defined as "non-responders." The radiomic risk score (RRS) was generated by using the least absolute shrinkage and selection operator (LASSO) with the Cox regression model. Patients were classified into the high-risk or low-risk groups based on the median of RRS. Association of the radiomic signature with OS was evaluated on Str and then tested on Ste. The features identified by LASSO were then used to train a linear discriminant analysis (LDA) classifier (MRad) to predict response to chemotherapy. A prognostic nomogram (NRad+Clin) was also developed on Str by combining clinical and prognostic radiomic features and validated on Ste. The Kaplan-Meier survival analysis and log-rank statistical tests were performed to assess the discriminative ability of the features. The discrimination performance of the NRad+Clin was assessed by Harrell's C-index. To estimate the clinical utility of the nomogram, decision curve analysis (DCA) was performed by calculating the net benefits for a range of threshold probabilities in predicting which high-risk patients should receive more aggressive treatment as compared with the low-risk patients. RESULTS A univariable Cox regression analysis indicated that RRS was significantly associated with OS in Str (HR: 1.53; 95% CI, [1.1-2.2; p = 0.021]; C-index = 0.72) and Ste (HR: 1.4, [1.1-1.82], p = 0.0127; C-index = 0.69). The RRS was also significantly associated with PFS in Str (HR: 1.89, [1.4-4.61], p = 0.047; C-index = 0.7) and Ste (HR: 1.641, [1.1-2.77], p = 0.04; C-index = 0.67). MRad was able to predict response to chemotherapy with an area under the receiver operating characteristic curve (AUC) of 0.76 ± 0.03 within Str and 0.72 within Ste. Predictors, including the RRS, gender, age, stage, and smoking status, were used in the prognostic nomogram. The discrimination ability of the NRad+Clin model on Str and Ste was C-index [95% CI]: 0.68 [0.66-0.71] and 0.67 [0.63-0.69], respectively. DCA indicated that the NRad+Clin model was clinically useful. CONCLUSIONS Radiomic features extracted within and around the lung tumor on CT images were both prognostic of OS and predictive of response to chemotherapy in SCLC patients.
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Affiliation(s)
- Prantesh Jain
- Department of Hematology and Oncology, University Hospitals Cleveland Medical Center, Cleveland, OH, United States
| | - Mohammadhadi Khorrami
- Department of Biomedical Engineering, Case Western Reserve University, Cleveland, OH, United States
| | - Amit Gupta
- Department of Radiology, University Hospitals Cleveland Medical Center, Cleveland, OH, United States
| | - Prabhakar Rajiah
- Department of Radiology, Mayo Clinic Minnesota, Rochester, MN, United States
| | - Kaustav Bera
- Department of Biomedical Engineering, Case Western Reserve University, Cleveland, OH, United States
| | - Vidya Sankar Viswanathan
- Department of Biomedical Engineering, Case Western Reserve University, Cleveland, OH, United States
| | - Pingfu Fu
- Department of Population and Quantitative Health Sciences, Case Western Reserve University (CWRU), Cleveland, OH, United States
| | - Afshin Dowlati
- Department of Hematology and Oncology, University Hospitals Cleveland Medical Center, Cleveland, OH, United States
| | - Anant Madabhushi
- Department of Biomedical Engineering, Case Western Reserve University, Cleveland, OH, United States
- Louis Stokes Cleveland Veterans Administration Medical Center, Cleveland, OH, United States
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Zeng C, Li N, Li F, Zhang P, Wu K, Liu D, Zhao S. Prognostic factors of patients with small cell lung cancer after surgical treatment. ANNALS OF TRANSLATIONAL MEDICINE 2021; 9:1146. [PMID: 34430587 PMCID: PMC8350721 DOI: 10.21037/atm-21-2912] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/22/2021] [Accepted: 07/14/2021] [Indexed: 12/12/2022]
Abstract
Background The current National Comprehensive Cancer Network guidelines recommend surgical treatment for patients with stages I–IIA small cell lung cancer (SCLC), but it still cannot deny the effect of surgical treatment on other limited-stage SCLC. Although more advanced diagnostic methods are now used for the diagnosis and classification of SCLC, the selection of surgical candidates is still arbitrary. Methods Data were collected from patients with SCLC who underwent surgery at the First Affiliated Hospital of Zhengzhou University from January 2011 to January 2021. Kaplan-Meier method was used to calculate cumulative survival curves, and log-rank test was used to evaluate differences among different subgroups. The Cox proportional hazard regression model was used to assess the predictive power of the variables for prognosis and survival. Results Smoking index, surgical resection method, TNM stage of postoperative pathology, and postoperative chemotherapy were significantly correlated with postoperative survival (P<0.05), which were independent predictors for postoperative survival. Patients with a smoking index >800 had a higher risk of death after surgery [hazard ratio (HR): 7.050, 95% confidence interval (CI): 3.079–16.143, P<0.001]. Compared with patients who underwent pulmonary lobectomy, those who underwent other pneumoresections (e.g., wedge resection, segmental resection, sleeve resection) had an increased risk of death (HR: 2.822, 95% CI: 1.030–7.734, P=0.044). Compared with stage I patients, stage II and stage III patients had an increased risk of death, with HRs of 6.039 and 3.145, respectively. Compared with those who received ≤4 courses of postoperative chemotherapy, those who received >4 courses of postoperative chemotherapy had reduced postoperative mortality risk (HR: 0.211, 95% CI: 0.097–0.459, P<0.001). Conclusions A high smoking index suggests worse prognosis; therefore, patients who smoke should be advised to quit smoking. Compared with stage II and stage III patients, surgical treatment is recommended for stage I SCLC patients. TNM staging, especially N staging, should be evaluated prior to surgery. Pulmonary lobectomy with mediastinal lymph node dissection should be the preferred surgical treatment for patients with SCLC. Patients should receive at least 5 courses of adjuvant chemotherapy after surgery.
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Affiliation(s)
- Cheng Zeng
- Department of Thoracic Surgery, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Nana Li
- Department of Respiratory Medicine, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Feng Li
- Department of Thoracic Surgery, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Peng Zhang
- Department of Thoracic Surgery, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Kai Wu
- Department of Thoracic Surgery, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Donglei Liu
- Department of Thoracic Surgery, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Song Zhao
- Department of Thoracic Surgery, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
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Heo IR, Kim HC, Lee SJ, Yoo JW, Ju S, Jeong YY, Lee JD, Cho YJ, Jeong JH, Heo M, Jung SW, Kim TH. Impact of coexistent preserved ratio impaired spirometry on the survival of patients with lung cancer: Analysis of data from the Korean Association for Lung Cancer Registry. Thorac Cancer 2021; 12:2478-2486. [PMID: 34337879 PMCID: PMC8447913 DOI: 10.1111/1759-7714.14095] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2021] [Revised: 07/15/2021] [Accepted: 07/16/2021] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND Preserved ratio impaired spirometry (PRISm) is a common spirometric pattern that is associated with respiratory symptoms and higher mortality rates. However, the relationship between lung cancer and PRISm remains unclear. This study investigated the clinical characteristics of lung cancer patients with PRISm and the potential role of PRISm as a prognostic factor. METHODS We retrospectively reviewed data collected from 2014 to 2015 in the Korean Association for Lung Cancer Registry. We classified all patients into three subgroups according to lung function as follows: normal lung function; PRISm (forced expiratory volume in 1 s [FEV1 ] < 80% predicted and FEV1 /forced vital capacity [FVC] ≥ 0.7); and chronic obstructive pulmonary disease (COPD; FEV1/FVC < 0.7). In non-small cell lung cancer (NSCLC) and small cell lung cancer (SCLC), the overall survival period was compared among the three subgroups. The prognostic factors were investigated using Cox regression analysis. RESULTS Of the 3763 patients, 38.6%, 40.1%, and 21.3% had normal lung function, COPD, and PRISm, respectively. Patients with PRISm had poorer overall survival than those with COPD or normal lung function in NSCLC and SCLC (Mantel-Cox log-rank test, p < 0.05). In the risk-adjusted analysis, overall survival was independently associated with COPD (hazard ratio [HR] 1.209, p = 0.027) and PRISm (HR 1.628, p < 0.001) in NSCLC, but was only associated with PRISm (HR 1.629, p = 0.004) in SCLC. CONCLUSIONS PRISm is a significant pattern of lung function in patients with lung cancer. At the time of lung cancer diagnosis, pre-existing PRISm should be considered a predictive factor of poor prognosis.
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Affiliation(s)
- I Re Heo
- Department of Internal Medicine, Gyeongsang National University School of Medicine and Gyeongsang National University Changwon Hospital, Changwon, Republic of Korea
| | - Ho Cheol Kim
- Department of Internal Medicine, Gyeongsang National University School of Medicine and Gyeongsang National University Changwon Hospital, Changwon, Republic of Korea
| | - Seung Jun Lee
- Department of Internal Medicine, Gyeongsang National University School of Medicine and Gyeongsang National University Hospital, Jinju, Republic of Korea
| | - Jung-Wan Yoo
- Department of Internal Medicine, Gyeongsang National University School of Medicine and Gyeongsang National University Hospital, Jinju, Republic of Korea
| | - Sunmi Ju
- Department of Internal Medicine, Gyeongsang National University School of Medicine and Gyeongsang National University Hospital, Jinju, Republic of Korea
| | - Yi Yeong Jeong
- Department of Internal Medicine, Gyeongsang National University School of Medicine and Gyeongsang National University Hospital, Jinju, Republic of Korea
| | - Jong Deog Lee
- Department of Internal Medicine, Gyeongsang National University School of Medicine and Gyeongsang National University Hospital, Jinju, Republic of Korea
| | - Yu Ji Cho
- Department of Internal Medicine, Gyeongsang National University School of Medicine and Gyeongsang National University Hospital, Jinju, Republic of Korea
| | - Jong Hwan Jeong
- Department of Internal Medicine, Gyeongsang National University School of Medicine and Gyeongsang National University Hospital, Jinju, Republic of Korea
| | - Manbong Heo
- Department of Internal Medicine, Gyeongsang National University School of Medicine and Gyeongsang National University Hospital, Jinju, Republic of Korea
| | - Seung Woo Jung
- Department of Critical Care Medicine, Gyeongsang National University School of Medicine and Gyeongsang National University Changwon Hospital, Changwon, Republic of Korea
| | - Tae Hoon Kim
- Department of Internal Medicine, Gyeongsang National University School of Medicine and Gyeongsang National University Changwon Hospital, Changwon, Republic of Korea
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Chiang CL, Hsieh WT, Tang CH, Sheu ML, Chen YM. Treatment patterns and survival in patients with small cell lung cancer in Taiwan. J Chin Med Assoc 2021; 84:772-777. [PMID: 34183592 DOI: 10.1097/jcma.0000000000000576] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND Small cell lung cancer (SCLC) is the most aggressive form of lung cancer. The chemotherapy regimens and their efficacy in practice are seldom reported. We aimed to investigate treatment patterns and survival outcomes of patients with SCLC in Taiwan. METHODS Patients newly diagnosed with SCLC from 2011 to 2015 were identified from the Cancer Registry database. Their clinical characteristics, treatment regimens, and survival status were obtained from National Health Insurance Research database. The Kaplan-Meier method and Cox-proportional hazard model were used to analyze the survival outcomes. RESULTS Among a total of 2707 patients enrolled, 439 were in the limited stage (LS, 16.22%) and 2268 were in the extensive stage of the disease (ES, 83.78%). The median age was 66 and the majority were male (90.36%). The first-line regimen used for the patients was etoposide/cisplatin-based treatment, followed by etoposide/carboplatin-based regimen, and etoposide only. The median overall survival (OS) was 16.92 months (95% confidence interval [CI] 15.31-18.92) and 8.71 months (95% CI 8.38-9.07) in LS and ES patients, respectively. Chemotherapy regimen, Eastern Cooperative Oncology Group performance status, and history of radiotherapy were significant factors associated with OS. On the other hand, the major second-line treatment was a topotecan-based regimen (68.3%). However, this showed inferior survival outcome compared to etoposide-based regimen (5.09 months [95% CI 4.76-5.62] versus 8.77 months [95% CI 6.31-11.89], p < 0.001). CONCLUSION Etoposide is the preferred and superior first-line chemotherapy regimen in combination with platinum, and an alternative choice of second-line regimen for Taiwanese patients with SCLC.
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Affiliation(s)
- Chi-Lu Chiang
- Department of Chest Medicine, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
- School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan, ROC
- Institute of Clinical Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan, ROC
| | - Wen-Ting Hsieh
- School of Health Care Administration, Taipei Medical University, Taipei, Taiwan, ROC
| | - Chao-Hsiun Tang
- School of Health Care Administration, Taipei Medical University, Taipei, Taiwan, ROC
| | - Mei-Ling Sheu
- School of Health Care Administration, Taipei Medical University, Taipei, Taiwan, ROC
| | - Yuh-Min Chen
- Department of Chest Medicine, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
- School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan, ROC
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30
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Dingemans AMC, Früh M, Ardizzoni A, Besse B, Faivre-Finn C, Hendriks LE, Lantuejoul S, Peters S, Reguart N, Rudin CM, De Ruysscher D, Van Schil PE, Vansteenkiste J, Reck M. Small-cell lung cancer: ESMO Clinical Practice Guidelines for diagnosis, treatment and follow-up ☆. Ann Oncol 2021; 32:839-853. [PMID: 33864941 PMCID: PMC9464246 DOI: 10.1016/j.annonc.2021.03.207] [Citation(s) in RCA: 231] [Impact Index Per Article: 77.0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2020] [Revised: 03/23/2021] [Accepted: 03/30/2021] [Indexed: 12/17/2022] Open
Affiliation(s)
- A.-M. C. Dingemans
- Department of Pulmonology, Erasmus MC Cancer Institute, University Medical Center Rotterdam, Department of Respiratory Medicine, Rotterdam
- Department of Pulmonology, GROW School for Oncology and Developmental Biology, Maastricht University Medical Center, Maastricht, The Netherlands
| | - M. Früh
- Department of Oncology and Haematology, Kantonsspital St. Gallen, St. Gallen
- Department of Medical Oncology, University of Bern, Bern, Switzerland
| | - A. Ardizzoni
- Division of Medical Oncology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - B. Besse
- Gustave Roussy, Villejuif
- Paris-Saclay University, Orsay, France
| | - C. Faivre-Finn
- Division of Cancer Sciences, University of Manchester & The Christie, NHS Foundation Trust, Manchester, UK
| | - L. E. Hendriks
- Department of Pulmonology, GROW School for Oncology and Developmental Biology, Maastricht University Medical Center, Maastricht, The Netherlands
| | - S. Lantuejoul
- Department of Biopathology, Centre Léon Bérard, Grenoble Alpes University, Lyon, France
| | - S. Peters
- Department of Oncology, Centre Hospitalier Universitaire Vaudois, Lausanne University, Lausanne, Switzerland
| | - N. Reguart
- Department of Medical Oncology, Hospital Clínic and Translational Genomics and Targeted Therapeutics in Solid Tumors, Institut d’Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
| | - C. M. Rudin
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, USA
| | - D. De Ruysscher
- Department of Radiation Oncology (Maastro Clinic), GROW School for Oncology and Developmental Biology, Maastricht University Medical Center, Maastricht, The Netherlands
| | - P. E. Van Schil
- Department of Thoracic and Vascular Surgery, Antwerp University Hospital and University of Antwerp, Edegem, Belgium
| | - J. Vansteenkiste
- Department of Respiratory Oncology, University Hospital KU Leuven, Leuven, Belgium
| | - M. Reck
- Department of Thoracic Oncology, Airway Research Center North, German Center for Lung Research, Lung Clinic, Grosshansdorf, Germany
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31
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Franco F, Carcereny E, Guirado M, Ortega AL, López-Castro R, Rodríguez-Abreu D, García-Campelo R, Del Barco E, Juan O, Aparisi F, González-Larriba JL, Domine M, Trigo JM, Cobo M, Cerezo S, Calzas J, Massutí B, Bosch-Barrera J, García Coves P, Domènech M, Provencio M. Epidemiology, treatment, and survival in small cell lung cancer in Spain: Data from the Thoracic Tumor Registry. PLoS One 2021; 16:e0251761. [PMID: 34077442 PMCID: PMC8171958 DOI: 10.1371/journal.pone.0251761] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2021] [Accepted: 05/02/2021] [Indexed: 01/04/2023] Open
Abstract
BACKGROUND Small-cell lung cancer (SCLC) is an aggressive disease with high metastatic potential and poor prognosis. Due to its low prevalence, epidemiological and clinical information of SCLC patients retrieved from lung cancer registries is scarce. PATIENTS AND METHODS This was an observational multicenter study that enrolled patients with lung cancer and thoracic tumors, recruited from August 2016 to January 2020 at 50 Spanish hospitals. Demographic and clinical data, treatment patterns and survival of SCLC patients included in the Thoracic Tumor Registry (TTR) were analyzed. RESULTS With a total of 956 cases, the age of 64.7 ± 9.1 years, 78.6% were men, 60.6% smokers, and ECOG PS 0, 1 or ≥ 2 in 23.1%, 53.0% and 23.8% of cases, respectively. Twenty percent of patients had brain metastases at the diagnosis. First-line chemotherapy (CT), mainly carboplatin or cisplatin plus etoposide was administered to >90% of patients. In total, 36.0% and 13.8% of patients received a second and third line of CT, respectively. Median overall survival was 9.5 months (95% CI 8.8-10.2 months), with an estimated rate of 70.3% (95% CI 67.2-73.4%), 38.9% (95% CI 35.4-42.4%), and 14.8% (95% CI 11.8-17.8%) at 6, 12 and 24 months respectively. Median progression-free survival was 6.3 months. Higher mortality and progression rates were significantly associated with male sex, older age, smoking habit, and ECOG PS 1-2. Long-term survival (> 2 years) was confirmed in 6.6% of patients, showing a positive correlation with better ECOG PS, poor smoking and absence of certain metastases at diagnosis. CONCLUSION This study provides an updated overview of the clinical situation and treatment landscape of ES-SCLC in Spain. Our results might assist oncologists to improve current clinical practice towards a better prognosis for these patients.
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Affiliation(s)
- Fernando Franco
- Hospital Universitario Puerta de Hierro-Majadahonda, Madrid, Spain
| | - Enric Carcereny
- Catalan Institute of Oncology, Hospital Universitari Germans Trias i Pujol, B-ARGO, IGTP, Badalona, Spain
| | - Maria Guirado
- Hospital General Universitario de Elche, Elche, Spain
| | | | | | | | | | | | - Oscar Juan
- Hospital Universitario y Politécnico La Fe, Valencia, Spain
| | | | | | - Manuel Domine
- Hospital Universitario Fundación Jiménez Díaz, IIS-FJD, Madrid, Spain
| | - Jose M Trigo
- Unidad de Gestión Clínica Intercentros de Oncología Médica, Hospitales Universitarios Regional y Virgen de la Victoria, IBIMA, Málaga, Spain
| | - Manuel Cobo
- Unidad de Gestión Clínica Intercentros de Oncología Médica, Hospitales Universitarios Regional y Virgen de la Victoria, IBIMA, Málaga, Spain
| | - Sara Cerezo
- Hospital General La Mancha Centro, Alcázar de San Juan, Spain
| | - Julia Calzas
- Hospital Universitario de Fuenlabrada, Fuenlabrada, Spain
| | | | | | | | - Marta Domènech
- Catalan Institute of Oncology, Hospital Universitari Germans Trias i Pujol, B-ARGO, IGTP, Badalona, Spain
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32
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Ma X, Zhang Z, Chen X, Zhang J, Nie J, Da L, Hu W, Tian G, Wu D, Han J, Han S, Long J, Wang Y, Fang J. Prognostic factor analysis of patients with small cell lung cancer: Real-world data from 988 patients. Thorac Cancer 2021; 12:1841-1850. [PMID: 33955685 PMCID: PMC8201544 DOI: 10.1111/1759-7714.13846] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2020] [Revised: 12/31/2020] [Accepted: 12/31/2020] [Indexed: 12/25/2022] Open
Abstract
Background Small cell lung cancer (SCLC) is characterized by aggressive spread and poor prognosis, but has limited treatment options. Results of prognostic factors from randomized trials on treatment arrangement are conflicting and large‐scale real‐world analysis is lacking. Methods Patients diagnosed SCLC between 2008 and 2018 in Peking University Cancer Hospital were included in this study. Kaplan–Meier methods were adopted, and univariate analysis and multivariate Cox regression models were constructed to analyze prognostic factors. Results Among 1045 patients who presented to our center, 988 eligible patients were identified. Median overall survival (OS) was 16.0 months for the whole group, 24.0 months and 11.0 months for limited stage small cell lung cancer (LS‐SCLC) and extensive stage small cell lung cancer (ES‐SCLC), separately. Limited‐stage, good performance status (PS) (ECOG 0–1), response to primary systemic treatment, and patients who received initiative irradiation and three or more lines of chemotherapy were predicted to have better OS in the whole group. Only response to first‐line systemic therapy and prophylactic cranial irradiation (PCI) were independent prognostic factors of survival in LS‐SCLC; while good PS (ECOG 0–1), without liver, bone, or subcutaneous metastases, response to first‐line therapy, initial local irradiation, and three or more lines of systemic therapy predicted a favorable prognosis in ES‐SCLC. Conclusions The present study retrieved from large real–world data suggested that response to primary systemic therapy and aggressive radiotherapy are independent prognostic factors for SCLC. PCI and initiative irradiation for original or metastatic sites improved the OS in LS‐SCLC and ES‐SCLC, respectively.
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Affiliation(s)
- Xiangjuan Ma
- Department of Thoracic Oncology II, Peking University Cancer Hospital & Institute, Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Beijing, China
| | - Ziran Zhang
- Department of Thoracic Oncology II, Peking University Cancer Hospital & Institute, Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Beijing, China
| | - Xiaoling Chen
- Department of Thoracic Oncology II, Peking University Cancer Hospital & Institute, Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Beijing, China
| | - Jie Zhang
- Department of Thoracic Oncology II, Peking University Cancer Hospital & Institute, Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Beijing, China
| | - Jun Nie
- Department of Thoracic Oncology II, Peking University Cancer Hospital & Institute, Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Beijing, China
| | - Ling Da
- Department of Thoracic Oncology II, Peking University Cancer Hospital & Institute, Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Beijing, China
| | - Weiheng Hu
- Department of Thoracic Oncology II, Peking University Cancer Hospital & Institute, Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Beijing, China
| | - Guangming Tian
- Department of Thoracic Oncology II, Peking University Cancer Hospital & Institute, Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Beijing, China
| | - Di Wu
- Department of Thoracic Oncology II, Peking University Cancer Hospital & Institute, Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Beijing, China
| | - Jindi Han
- Department of Thoracic Oncology II, Peking University Cancer Hospital & Institute, Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Beijing, China
| | - Sen Han
- Department of Thoracic Oncology II, Peking University Cancer Hospital & Institute, Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Beijing, China
| | - Jieran Long
- Department of Thoracic Oncology II, Peking University Cancer Hospital & Institute, Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Beijing, China
| | - Yang Wang
- Department of Thoracic Oncology II, Peking University Cancer Hospital & Institute, Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Beijing, China
| | - Jian Fang
- Department of Thoracic Oncology II, Peking University Cancer Hospital & Institute, Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Beijing, China
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Han J, Fu C, Li B. Clinical outcomes of extensive-stage small cell lung cancer patients treated with thoracic radiotherapy at different times and fractionations. Radiat Oncol 2021; 16:47. [PMID: 33663551 PMCID: PMC7934361 DOI: 10.1186/s13014-021-01773-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2020] [Accepted: 02/18/2021] [Indexed: 02/06/2023] Open
Abstract
Objective The purpose of this study was to assess whether thoracic radiotherapy (TRT) combined with chemotherapy (CHT) showed promising anti-tumour activity in extensive-stage small cell lung cancer (ES-SCLC), to explore practice patterns for the radiation time and dose/fractionation and to identify prognostic factors for patients who would benefit from CHT/TRT. Methods A total of 492 ES-SCLC patients were included from January 2010 to March 2019, 244 of whom received CHT/TRT. Propensity score matching was performed to minimize bias between the CHT/TRT and CHT-alone groups. Patients in the CHT/TRT group were categorized into four subgroups based on the number of induction CHT cycles. For effective dose fractionation calculations, we introduced the time-adjusted biological effective dose (tBED). Categorical variables were analysed with chi-square tests and Fisher’s exact tests. Kaplan–Meier curves were generated to estimate survival rates using the R-project. Multivariate prognostic analysis was performed with Cox proportional hazards models. Results Patients who received CHT/TRT experienced improved overall survival (OS) (18.1 vs 10.8 months), progression-free survival (PFS) (9.3 vs 6.0 months) and local recurrence-free survival (LRFS) (12.0 vs 6.6 months) before matching, with similar results after matching. In the CHT/TRT group, the median LRFS times for the groups based on the radiation time were 12.7, 12.0, 12.0, and 9.0 months, respectively. Early TRT had a tendency to prolong PFS (median 10.6 vs 9.8 vs 9.0 vs 7.7 months, respectively, p = 0.091) but not OS (median 17.6 vs 19.5 vs 17.2 vs 19.0 months, respectively, p = 0.622). Notably, patients who received TRT within 6 cycles of CHT experienced prolonged LRFS (p = 0.001). Regarding the radiation dose, patients in the high-dose group (tBED > 50 Gy) who achieved complete response and partial response (CR and PR) to systemic therapy had relatively short OS (median 27.1 vs 22.7, p = 0.026) and PFS (median 11.4 vs 11.2, p = 0.032), but the abovementioned results were not obtained after the exclusion of patients who received hyperfractionated radiotherapy (all p > 0.05). Conclusion CHT/TRT could improve survival for ES-SCLC patients. TRT performed within 6 cycles of CHT and hyperfractionated radiotherapy (45 Gy in 30 fractions) may be a feasible treatment scheme for ES-SCLC patients. Supplementary Information The online version contains supplementary material available at 10.1186/s13014-021-01773-x.
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Affiliation(s)
- Jinmin Han
- Shandong First Medical University and Shandong Academy of Medical Sciences, Jinan, 250117, Shandong, China.,Department of Radiation Oncology, Shandong Cancer Hospital and Institute, Shandong First Medical University and Shandong Academy of Medical Sciences, Jinan, 250117, Shandong, China
| | - Chengrui Fu
- Department of Radiation Oncology, Shandong Cancer Hospital and Institute, Shandong First Medical University and Shandong Academy of Medical Sciences, Jinan, 250117, Shandong, China.,Department of Radiation Oncology, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer, Key Laboratory of Cancer Prevention and Therapy, Tianjin's Clinical Research Center for Cancer, Tianjin, 300060, China
| | - Baosheng Li
- Department of Radiation Oncology, Shandong Cancer Hospital and Institute, Shandong First Medical University and Shandong Academy of Medical Sciences, Jinan, 250117, Shandong, China.
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34
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Megyesfalvi Z, Tallosy B, Pipek O, Fillinger J, Lang C, Klikovits T, Schwendenwein A, Hoda MA, Renyi-Vamos F, Laszlo V, Rezeli M, Moldvay J, Dome B. The landscape of small cell lung cancer metastases: Organ specificity and timing. Thorac Cancer 2021; 12:914-923. [PMID: 33533174 PMCID: PMC7952793 DOI: 10.1111/1759-7714.13854] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2020] [Accepted: 01/06/2021] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND Early metastasis is a hallmark of small cell lung cancer (SCLC). However, the mechanisms and resulting patterns of SCLC dissemination are unclear. Our aim was thus to investigate the organ specificity and timing of blood-borne metastases in a comprehensive large cohort of SCLC patients. METHODS In this retrospective non-interventional cross-sectional study of 1009 Caucasian SCLC patients, we investigated the correlation between the distinct locations of the primary tumor and metastatic sites. RESULTS The onset of bone (p < 0.001), brain (p < 0.001), and pericardial (p = 0.02) metastases were late events, whereas adrenal gland (p = 0.005) and liver (p < 0.001) metastases occurred earlier. No significant difference was found in the distribution of early versus late metastases when comparing central and peripheral primary tumors. Patients with bone metastases had a higher than expected likelihood of having liver metastases, while brain metastases tended to appear together with adrenal gland metastases. Pleural and both lung and pericardial metastases also tended to co-metastasize together more frequently than expected if metastatic events occurred independently. Notably, patients with central primary tumors had decreased median overall survival (OS) compared to those with peripheral tumors, although this tendency does not appear to be significant (p = 0.072). CONCLUSION Our results are suggestive for particular site- and sequence-specific metastasis patterns in human SCLC. SCLC bone metastases tend to appear together with liver metastases, while brain metastases occur together with adrenal gland metastases. Better understanding of metastasis distribution patterns might help to improve the diagnosis and therapeutic decision-making in SCLC patients.
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Affiliation(s)
- Zsolt Megyesfalvi
- Department of Thoracic Surgery, Semmelweis University and National Institute of Oncology, Budapest, Hungary.,National Koranyi Institute of Pulmonology, Budapest, Hungary.,Department of Thoracic Surgery, Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria
| | - Bernadett Tallosy
- Department of Thoracic Surgery, Semmelweis University and National Institute of Oncology, Budapest, Hungary
| | - Orsolya Pipek
- Department of Physics of Complex Systems, Eötvös Loránd University, Budapest, Hungary
| | - Janos Fillinger
- Department of Thoracic Surgery, Semmelweis University and National Institute of Oncology, Budapest, Hungary.,National Koranyi Institute of Pulmonology, Budapest, Hungary
| | - Christian Lang
- Department of Thoracic Surgery, Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria
| | - Thomas Klikovits
- Department of Thoracic Surgery, Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria
| | - Anna Schwendenwein
- Department of Thoracic Surgery, Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria
| | - Mir Alireza Hoda
- Department of Thoracic Surgery, Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria
| | - Ferenc Renyi-Vamos
- Department of Thoracic Surgery, Semmelweis University and National Institute of Oncology, Budapest, Hungary.,National Koranyi Institute of Pulmonology, Budapest, Hungary
| | - Viktoria Laszlo
- National Koranyi Institute of Pulmonology, Budapest, Hungary.,Department of Thoracic Surgery, Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria
| | - Melinda Rezeli
- Department of Biomedical Engineering, Lund University, Lund, Sweden
| | - Judit Moldvay
- National Koranyi Institute of Pulmonology, Budapest, Hungary.,2nd Department of Pathology, Semmelweis University, Budapest, Hungary.,MTA-SE NAP, Brain Metastasis Research Group, Hungarian Academy of Sciences, Budapest, Hungary
| | - Balazs Dome
- Department of Thoracic Surgery, Semmelweis University and National Institute of Oncology, Budapest, Hungary.,National Koranyi Institute of Pulmonology, Budapest, Hungary.,Department of Thoracic Surgery, Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria
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Geng N, Ding CM, Liu ZK, Song S, Hu WX. Influence of VEGFR2 gene polymorphism on the clinical outcomes of apatinib for patients with chemotherapy-refractory extensive-stage SCLC: a real-world retrospective study. Int J Clin Oncol 2021; 26:670-683. [PMID: 33392882 DOI: 10.1007/s10147-020-01849-w] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2020] [Accepted: 11/25/2020] [Indexed: 01/07/2023]
Abstract
PURPOSE Great individual differences were observed regarding the efficacy of apatinib clinically. The aim of present study was to investigate the influence of vascular endothelial growth factor receptor2 (VEGFR2) gene polymorphism on the clinical outcomes of apatinib for patients with chemotherapy-refractory extensive-stage small cell lung cancer (ES-SCLC). METHODS A total of 128 patients with chemotherapy-refractory ES-SCLC who were treated with apatinib at an initial dosage of 250 or 500 mg were included in this study. The change of target lesions was assessed. Overall response rate (ORR) was evaluated. Prognosis was carried out and safety profile was documented. Additionally, peripheral blood and biopsy cancer tissue specimens of the patients with SCLC were collected for the analysis of polymorphism and VEGFR2 gene mRNA expression, respectively. The association between genotype status and baseline characteristics was performed. Univariate analysis of genotype status and prognosis was carried out using Kaplan-Meier survival analysis and multivariate analysis were adjusted by Cox regression analysis. RESULTS Efficacy of apatinib included partial response (PR) in 15 patients, stable disease (SD) in 86 patients, progressive disease (PD) in 27 patients. Therefore, ORR of the 128 patients with ES-SCLC was 11.7%, and disease control rate (DCR) was 78.9%. Prognosis suggested that the median progression-free survival (PFS) and overall survival (OS) of the 128 patients with ES-SCLC was 4.2 months and 8.2 months, respectively. The polymorphism analysis focusing on VEGFR2 gene indicated that one single nucleotide polymorphism 889C>T was of clinical significance. Prevalence of 889C>T among the 128 patients with SCLC were as follows: CC genotype 87 cases (68.0%), CT genotype 38 cases (29.7%) and TT genotype 3 cases (2.3%), the minor allele frequency of 889C>T was 0.17, which was in accordance with Hardy-Weinberg Equilibrium (P = 0.628). Patients with CT and TT genotypes were merged in the subsequent analysis. Prognosis analysis exhibited that the median PFS of patients with CT/TT genotype and CC genotype was 3.3 and 5.0 months, respectively (P = 0.02). Furthermore, the median OS of patients was 5.5 and 9.0 months, respectively (P = 0.008). Additionally, multivariate Cox regression analysis of OS demonstrated that CT/TT genotype was an independent factor for OS [Hazard ratio (HR) = 0.64, P = 0.019]. However, the safety profile according to genotype status of 889C>T failed to show significant difference. Interestingly, mRNA expression analysis suggested that the mRNA expression of VEGFR2 in cancer tissues were significantly different according to CC and CT/TT genotypes (P < 0.001). CONCLUSION The administration with apatinib for patients with chemotherapy-refractory ES-SCLC was of potential clinical significance. The clinical outcomes of patients with ES-SCLC who were treated with apatinib could be impacted by VEGFR2 889C>T polymorphism through mediating the VEGFR2 mRNA expression.
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Affiliation(s)
- Nan Geng
- Department of Respiratory Medicine, The Fourth Hospital of Hebei Medical University, 12 Jian-Kang Road, Shijiazhuang, 050012, People's Republic of China
| | - Cui-Min Ding
- Department of Respiratory Medicine, The Fourth Hospital of Hebei Medical University, 12 Jian-Kang Road, Shijiazhuang, 050012, People's Republic of China
| | - Zhi-Kun Liu
- Department of Radiotherapy, The Fourth Hospital of Hebei Medical University, Shijiazhuang, 050012, People's Republic of China
| | - Shan Song
- Department of Respiratory Medicine, The Fourth Hospital of Hebei Medical University, 12 Jian-Kang Road, Shijiazhuang, 050012, People's Republic of China
| | - Wen-Xia Hu
- Department of Respiratory Medicine, The Fourth Hospital of Hebei Medical University, 12 Jian-Kang Road, Shijiazhuang, 050012, People's Republic of China.
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Sung P, Yoon SH, Kim J, Hong JH, Park S, Goo JM. Bronchovascular bundle thickening on CT as a predictor of survival and brain metastasis in patients with stage IA peripheral small cell lung cancer. Clin Radiol 2020; 76:76.e37-76.e46. [PMID: 32948314 DOI: 10.1016/j.crad.2020.08.018] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2020] [Accepted: 08/19/2020] [Indexed: 01/03/2023]
Abstract
AIM To determine if bronchovascular bundle (BVB) thickening on pretreatment computed tomography (CT) images helps predict survival in patients with peripheral small cell lung cancer (pSCLC) ≤3 cm. MATERIALS AND METHODS The pretreatment CT examinations of 79 histopathologically proven pSCLC ≤3 cm (TNM stage I, 21; II, 13; III, 22; IV, 23) were reviewed retrospectively. The CT characteristics of the nodule and associated findings, including BVB thickening, were evaluated. Progression-free survival (PFS), overall survival (OS), and brain metastasis-free survival were compared with the presence of BVB thickening using Kaplan-Meier and Cox regression analysis. RESULTS Among the 79 patients, 34 (43%) had BVB thickening. BVB thickening was prevalent in patients with mediastinal lymph node metastasis (50.9% versus 22.7%; p=0.024) and distant metastasis (60.9% versus 35.7%; p=0.049). Out of the 21 patients with TNM stage IA disease, the 16 patients (76.2%) without BVB thickening showed better PFS, OS, and brain metastasis-free survival (mean, 1,762 versus 483 days; p=0.019: 2,243 versus 1,328 days; p=0.038: 2,274 versus 1,287 days; p=0.038, respectively). Multivariate Cox regression analysis showed that the absence of BVB thickening (hazard ratio [HR], 7.806; 95% CI, 1.241-49.091; p=0.029) and surgery (HR, 0.075; 95% CI, 0.008-0.746; p=0.027) were independent and useful prognostic factors for PFS. CONCLUSIONS BVB thickening was found more frequently in patients with advanced-stage pSCLC ≤3 cm, and the PFS was more favourable in patients without BVB thickening, with a similar tendency to that of OS and brain metastasis-free survival, in stage IA pSCLC.
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Affiliation(s)
- P Sung
- Department of Radiology, Seoul National University Hospital, 101 Daehak-ro, Jongno-gu, Seoul, 03080, South Korea
| | - S H Yoon
- Department of Radiology, Seoul National University Hospital, 101 Daehak-ro, Jongno-gu, Seoul, 03080, South Korea; Department of Radiology, Seoul National University College of Medicine, 103 Daehak-ro, Jongno-gu, Seoul, 030804, South Korea.
| | - J Kim
- Department of Radiology, Seoul National University Bundang Hospital, Seoul National University College of Medicine, 300 Gumi-dong, Bundang-gu, Seongnam, Gyeonggi-do, 13620, South Korea
| | - J H Hong
- Department of Radiology, Seoul National University Hospital, 101 Daehak-ro, Jongno-gu, Seoul, 03080, South Korea
| | - S Park
- Department of Thoracic and Cardiovascular Surgery, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, South Korea
| | - J M Goo
- Department of Radiology, Seoul National University Hospital, 101 Daehak-ro, Jongno-gu, Seoul, 03080, South Korea; Department of Radiology, Seoul National University College of Medicine, 103 Daehak-ro, Jongno-gu, Seoul, 030804, South Korea; Institute of Radiation Medicine, Seoul National University Medical Research Center, 103 Daehak-ro, Jongno-gu, Seoul, 03080, South Korea
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Gao H, Dang Y, Qi T, Huang S, Zhang X. Mining prognostic factors of extensive-stage small-cell lung cancer patients using nomogram model. Medicine (Baltimore) 2020; 99:e21798. [PMID: 32872080 PMCID: PMC7437828 DOI: 10.1097/md.0000000000021798] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
This study is to establish the nomogram model and provide clinical therapy decision-making for extensive-stage small-cell lung cancer (ES-SCLC) patients with different metastatic sites using the Surveillance, Epidemiology, and End Results (SEER) Program.A total of 10,025 patients of ES-SCLC with metastasis from January 2010 to December 2016 were enrolled from the SEER database. All samples were randomly divided into a derivation cohort and a validation cohort, and the derivation cohort was divided into 6 groups by different metastatic sites: bone, liver, lung, brain, multiple organs, and other organs. Using Cox proportional hazards models to analyze candidate prognostic factors, screening out the independent prognostic factors to establish the nomogram. Compare the different models by Net reclassification improvement and integrated discrimination improvement. Concordance index (C-index) and the calibration curve were used to verify the prediction efficiency of the nomogram in the derivation cohort and validation cohort.In the derivation cohort, the median overall survival was 7 months. The overall survival rates at 6-month, 1-year, and 2-year were 55.07%, 24.61%, and 7.56%, respectively. The median survival time was 10, 8, 7, 9, 7, and 6 months for the 6 groups of different metastatic sites: other, bone, liver, lung, brain, and multiple organs, respectively. Age, sex, race, T, N, distant metastatic site, and chemotherapy were contained in the final nomogram prognostic model. The C-index was 0.6569777 in the derivation cohort and 0.8386301 in the validation cohort.The survival time of ES-SCLC patients with different metastatic sites was significantly different. The nomogram can effectively predict the prognosis of individuals and provide a basis for clinical decision-making.
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Affiliation(s)
- Hongxiang Gao
- Radiotherapy Department, The First Affiliated Hospital of Xi’an Jiaotong University
- Department of Oncology, Chang An Hospital
| | - Yazheng Dang
- Radiotherapy Department, 986 Hospital affiliated to The Fourth Military Medical University, Xi’an, Shaan Xi
| | - Tao Qi
- Radiotherapy Department, 986 Hospital affiliated to The Fourth Military Medical University, Xi’an, Shaan Xi
| | - Shigao Huang
- Faculty of Health Sciences, University of Macau, Taipa, Macao SAR, China
| | - Xiaozhi Zhang
- Radiotherapy Department, The First Affiliated Hospital of Xi’an Jiaotong University
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Wang Y, Pang Z, Chen X, Yan T, Liu J, Du J. Development and validation of a prognostic model of resectable small-cell lung cancer: a large population-based cohort study and external validation. J Transl Med 2020; 18:237. [PMID: 32539859 PMCID: PMC7296644 DOI: 10.1186/s12967-020-02412-x] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2019] [Accepted: 06/09/2020] [Indexed: 12/11/2022] Open
Abstract
Background Survival outcomes of patients with resected SCLC differ widely. The aim of our study was to build a model for individualized risk assessment and accurate prediction of overall survival (OS) in resectable SCLC patients. Methods We collected 1052 patients with resected SCLC from the Surveillance, Epidemiology, and End Results (SEER) database. Independent prognostic factors were selected by COX regression analyses, based on which a nomogram was constructed by R code. External validation were performed in 114 patients from Shandong Provincial Hospital. We conducted comparison between the new model and the AJCC staging system. Kaplan–Meier survival analyses were applied to test the application of the risk stratification system. Results Sex, age, T stage, N stage, LNR, surgery and chemotherapy were identified to be independent predictors of OS, according which a nomogram was built. Concordance index (C-index) of the training cohort were 0.721, 0.708, 0.726 for 1-, 3- and 5-year OS, respectively. And that in the validation cohort were 0.819, 0.656, 0.708, respectively. Calibration curves also showed great prediction accuracy. In comparison with 8th AJCC staging system, improved net benefits in decision curve analyses (DCA) and evaluated integrated discrimination improvement (IDI) were obtained. The risk stratification system can significantly distinguish the ones with different survival risk. We implemented the nomogram in a user-friendly webserver. Conclusions We built a novel nomogram and risk stratification system integrating clinicopathological characteristics and surgical procedure for resectable SCLC. The model showed superior prediction ability for resectable SCLC.
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Affiliation(s)
- Yu Wang
- Institute of Oncology, Shandong Provincial Hospital, Affiliated to Shandong First Medical University, 324 Jingwu Road, Jinan, 250021, Shandong, People's Republic of China
| | - Zhaofei Pang
- Institute of Oncology, Shandong Provincial Hospital, Affiliated to Shandong First Medical University, 324 Jingwu Road, Jinan, 250021, Shandong, People's Republic of China.,Department of Oncology, Shandong Provincial Hospital, Affiliated to Shandong First Medical University, 324 Jingwu Road, Jinan, 250021, Shandong, China
| | - Xiaowei Chen
- Institute of Oncology, Shandong Provincial Hospital, Affiliated to Shandong First Medical University, 324 Jingwu Road, Jinan, 250021, Shandong, People's Republic of China
| | - Tao Yan
- Institute of Oncology, Shandong Provincial Hospital, Affiliated to Shandong First Medical University, 324 Jingwu Road, Jinan, 250021, Shandong, People's Republic of China
| | - Jichang Liu
- Institute of Oncology, Shandong Provincial Hospital, Affiliated to Shandong First Medical University, 324 Jingwu Road, Jinan, 250021, Shandong, People's Republic of China
| | - Jiajun Du
- Institute of Oncology, Shandong Provincial Hospital, Affiliated to Shandong First Medical University, 324 Jingwu Road, Jinan, 250021, Shandong, People's Republic of China. .,Department of Thoracic Surgery, Shandong Provincial Hospital, Affiliated to Shandong First Medical University, 324 Jingwu Road, Jinan, 250021, Shandong, China.
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Abstract
Small cell lung cancer (SCLC) is an aggressive malignancy and carries a poor prognosis with limited effective treatments in the advanced setting. SCLC is characterized by a high tumor mutation burden and alterations in Notch signaling and DNA damage repair pathways, providing rationale for the use of immunotherapy and targeted therapies. Immunotherapies have led to the most significant advances in treating SCLC in decades, and several promising targeted approaches have emerged from the increased understanding of the biology of SCLC. However, responses to these novel approaches are far from universal, and efforts to refine these therapies are ongoing.
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Sonehara K, Tateishi K, Komatsu M, Yamamoto H, Hanaoka M. Lung immune prognostic index as a prognostic factor in patients with small cell lung cancer. Thorac Cancer 2020; 11:1578-1586. [PMID: 32286017 PMCID: PMC7262905 DOI: 10.1111/1759-7714.13432] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2020] [Revised: 03/23/2020] [Accepted: 03/24/2020] [Indexed: 12/24/2022] Open
Abstract
Background The lung immune prognostic index (LIPI) is a marker that combines the derived neutrophil‐to‐lymphocyte ratio (dNLR) and serum lactate dehydrogenase (LDH) level and is a recently reported prognostic factor of immune checkpoint inhibitor therapy for non‐small cell lung cancer (NSCLC). However, there are no reports regarding the prognostic value of LIPI in small cell lung cancer (SCLC). Methods We retrospectively enrolled 171 patients diagnosed with SCLC and treated at Shinshu University School of Medicine between January 2003 and November 2019. Progression‐free survival (PFS) and overall survival (OS) were compared according to LIPI, and we investigated whether LIPI could be a prognostic factor in SCLC using the Kaplan‐Meier method and univariate and multivariate Cox models. Results The median OS of the LIPI 0 group was significantly longer than that of the LIPI 1 plus 2 group (21.0 vs. 11.6 months, P < 0.001). The multivariate analysis associated with OS indicated that LIPI 1 plus 2 was an independent unfavorable prognostic factor in addition to poor performance status (2–3), old age (≥ 75 years) and stage (extensive disease [ED]). However, PFS of the LIPI 0 group was not significantly different from that of the LIPI 1 plus 2 group. In ED‐SCLC patients, the median PFS and OS of the LIPI 0 group were significantly longer than those of the LIPI 2 group (6.6 vs. 4.0 months, P = 0.006 and 17.1 vs. 5.9 months, P < 0.001, respectively). Conclusions We confirmed the prognostic value of LIPI in SCLC, especially ED‐SCLC. Key points Significant findings of the study: The present study is the first to demonstrate that pretreatment lung immune prognostic index is an independent prognostic factor associated with overall survival for small cell lung cancer. What this study adds: The utility of the lung immune prognostic index as a prognostic factor for small cell lung cancer.
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Affiliation(s)
- Kei Sonehara
- First Department of Internal Medicine, Shinshu University School of Medicine, Matsumoto City, Japan
| | - Kazunari Tateishi
- First Department of Internal Medicine, Shinshu University School of Medicine, Matsumoto City, Japan
| | - Masamichi Komatsu
- First Department of Internal Medicine, Shinshu University School of Medicine, Matsumoto City, Japan
| | - Hiroshi Yamamoto
- First Department of Internal Medicine, Shinshu University School of Medicine, Matsumoto City, Japan
| | - Masayuki Hanaoka
- First Department of Internal Medicine, Shinshu University School of Medicine, Matsumoto City, Japan
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Wang Y, Wu Y, Li J, Li J, Che G. Clinicopathological and prognostic significance of thyroid transcription factor-1 expression in small cell lung cancer: A systemic review and meta-analysis. Pathol Res Pract 2019; 215:152706. [DOI: 10.1016/j.prp.2019.152706] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/15/2019] [Revised: 10/11/2019] [Accepted: 10/19/2019] [Indexed: 01/11/2023]
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Lee GW, Go SI, Kim DW, Kim HG, Kim JH, An HJ, Jang JS, Kim BS, Hahn S, Heo DS. Geriatric Nutritional Risk Index as a prognostic marker in patients with extensive-stage disease small cell lung cancer: Results from a randomized controlled trial. Thorac Cancer 2019; 11:62-71. [PMID: 31707767 PMCID: PMC6938749 DOI: 10.1111/1759-7714.13229] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2019] [Revised: 10/03/2019] [Accepted: 10/04/2019] [Indexed: 01/04/2023] Open
Abstract
BACKGROUND Clinical impact of the Geriatric Nutritional Risk Index (GNRI) in patients with extensive-stage disease small cell lung cancer (ED-SCLC) have not previously been reported. METHODS This study analyzed 352 patients enrolled in a previous randomized phase III trial comparing the efficacy of irinotecan plus cisplatin with that of etoposide plus cisplatin as the first-line therapy for ED-SCLC. GNRI values were calculated using serum albumin levels and actual and ideal bodyweights. Patients with a GNRI > 98, 92-98, and <92 were grouped into no, low, and moderate/major risk groups, respectively. RESULTS The objective response rates were 63.2%, 52.6%, and 49.2% in the no, low, and moderate/major risk groups, respectively (P = 0.024). The median progression-free survival (PFS) was shorter in patients with a lower GNRI than in those with a higher GNRI (no vs. low vs. moderate/major risk group; 6.5 vs. 5.8 vs. 5.9 months, respectively; P = 0.028). There were significant differences in median overall survival (OS) according to GNRI (no vs. low vs. moderate/major risk group; 13.2 vs. 10.3 vs. 8.4 months, respectively; P < 0.001). Multivariate analysis revealed that being in the moderate/major risk group was an independent poor prognostic factor for PFS (hazard ratio [HR]: 1.300, 95% confidence interval [CI]: 1.012-1.670; P = 0.040) and OS (HR: 1.539; 95% CI: 1.069-2.216; P = 0.020). CONCLUSIONS This prospective study shows that a low GNRI value was associated with a poor prognosis, and it supports the relationship between systemic inflammation, nutritional status, and clinical outcomes in patients with ED-SCLC.Key points SIGNIFICANT FINDINGS OF THE STUDY: The lower GNRI group had a low response rate to chemotherapy for ED-SCLC. The HRs for PFS and OS were 1.300 and 1.539 in the patients with GNRI < 92. WHAT THIS STUDY ADDS Low GNRI is associated with poor prognosis in ED-SCLC.
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Affiliation(s)
- Gyeong-Won Lee
- Department of Internal Medicine, Gyeongsang National University Hospital, Gyeongsang National University School of Medicine, Jinju, Korea
| | - Se-Il Go
- Department of Internal Medicine, Gyeongsang National University Changwon Hospital, Gyeongsang National University School of Medicine, Changwon, Korea
| | - Dong-Wan Kim
- Department of Internal Medicine, Seoul National University Hospital, Seoul, Korea
| | - Hoon-Gu Kim
- Department of Internal Medicine, Gyeongsang National University Changwon Hospital, Gyeongsang National University School of Medicine, Changwon, Korea
| | - Joo-Hang Kim
- Department of Internal Medicine, Division of Medical Oncology, CHA Bundang Medical Center, CHA University, Seongnam, Korea
| | - Ho Jung An
- Division of Medical Oncology, Department of Internal Medicine, St. Vincent's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Joung Soon Jang
- Division of Hematology/Oncology, Department of Internal Medicine, Chung-Ang University College of Medicine, Seoul, Korea
| | - Bong-Seog Kim
- Division of Hemato-Oncology, Department of Internal Medicine, Veterans Health Service Medical Center, Seoul, Korea
| | - Seokyung Hahn
- Medical Research Collaborating Center, Seoul National University College of Medicine, Seoul, Korea
| | - Dae Seog Heo
- Department of Internal Medicine, Seoul National University Hospital, Seoul, Korea
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Zhang K, Xu Y, Tan S, Wang X, Du M, Liu L. The association between plasma fibrinogen levels and lung cancer: a meta-analysis. J Thorac Dis 2019; 11:4492-4500. [PMID: 31903237 DOI: 10.21037/jtd.2019.11.13] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Background Published studies have presented an inconsistent association between plasma fibrinogen level and poor prognosis or clinicopathological characteristics in lung cancer. Methods In the absence of significant quality difference, combined hazard ratios (HRs) and their corresponding 95% confidence intervals (CIs) were calculated according to overall survival (OS), progression-free survival (PFS) and disease-free survival (DFS). Risk ratio (RR), odds ratio (OR) and standardized mean difference (SMD) with CIs were pooled to appraise the effect of plasma fibrinogen on clinicopathological characteristics. Furthermore, we directly combined the P values to estimate the association of plasma fibrinogen and tumor size. We adjusted the publication bias using trim-and fill method. Results Twenty studies with 6,494 patients were contained in meta-analysis. The pooled data indicated that elevated fibrinogen level associated with poor prognosis in lung cancer. Typically, the pooled HRs were 1.44 (95% CI, 1.34-1.55), 1.49 (95% CI, 1.24-1.80) and 1.69 (95% CI, 1.31-2.17) for OS, PFS and DFS of lung cancer, respectively. In addition, the combined ORs were 1.50 (95% CI, 1.23-1.84) and 2.01 (95% CI, 1.66-2.44) for lymph node metastasis and III-IV stage; and the combined RR was 2.15 (95% CI, 1.11-4.15) for disease control rate (DCR). Moreover, patients with distant metastasis or III-IV stage had significantly higher plasma fibrinogen level (SMD: 0.20, 95% CI, 0.04-0.36; SMD: 0.31, 95% CI, 0.18-0.44, respectively). Conclusions The summary results indicated that plasma fibrinogen was a marker of prognosis and clinicopathological characteristics in lung cancer.
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Affiliation(s)
- Ke Zhang
- Department of Oncology, The First Affiliated Hospital of Nanjing Medical University, Nanjing 210029, China
| | - Ye Xu
- Department of Oncology, The First Affiliated Hospital of Nanjing Medical University, Nanjing 210029, China
| | - Shanyue Tan
- Department of Oncology, The First Affiliated Hospital of Nanjing Medical University, Nanjing 210029, China
| | - Xueyan Wang
- Department of Oncology, The First Affiliated Hospital of Nanjing Medical University, Nanjing 210029, China
| | - Mulong Du
- Department of Genetic Toxicology, The Key Laboratory of Modern Toxicology of Ministry of Education, School of Public Health, Nanjing Medical University, Nanjing 211166, China.,Department of Biostatistics, Nanjing Medical University, Nanjing 211166, China
| | - Lingxiang Liu
- Department of Oncology, The First Affiliated Hospital of Nanjing Medical University, Nanjing 210029, China
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Wang S, Zimmermann S, Parikh K, Mansfield AS, Adjei AA. Current Diagnosis and Management of Small-Cell Lung Cancer. Mayo Clin Proc 2019; 94:1599-1622. [PMID: 31378235 DOI: 10.1016/j.mayocp.2019.01.034] [Citation(s) in RCA: 157] [Impact Index Per Article: 31.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/04/2018] [Revised: 01/05/2019] [Accepted: 01/31/2019] [Indexed: 12/25/2022]
Abstract
Small-cell lung cancer (SCLC) is an aggressive disease with distinct pathological, clinical, and molecular characteristics from non-small-cell lung cancer. SCLC has high metastatic potential, resulting in a clinically poor prognosis. Early concurrent chemo-radiation is the standard of care for limited-stage SCLC (LS-SCLC). Prophylactic cranial irradiation (PCI) is recommended for patients with LS-SCLC without progression of disease after initial therapy. A combination of etoposide and cisplatin or carboplatin remains the mainstay of first-line treatment for ES-SCLC, with the addition of atezolizumab, now becoming standard. Most SCLCs initially respond to therapy but almost invariably recur. Topotecan and amrubicin (in Japan) remain the primary chemotherapy options for relapsed SCLC. Immunotherapy, including nivolumab with or without ipilimumab, is now available for refractory disease. In general, the poor prognosis of SCLC has not improved significantly for more than 3 decades. Recently, next-generation molecular profiling studies have identified new therapeutic targets for SCLC. A variety of proapoptotic agents, compounds capitalizing on DNA-repair defects, immunotherapy agents, and antibody-drug conjugates are being evaluated in SCLC, with a number of them showing early promise.
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Affiliation(s)
- Shuhang Wang
- Peking University Cancer Hospital, Beijing, China
| | - Stefan Zimmermann
- Département d'Oncologie, service d'Immuno-Oncologie, CHUV, Lausanne, Switzerland
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Shirasawa M, Fukui T, Kusuhara S, Harada S, Nishinarita N, Hiyoshi Y, Ishihara M, Kasajima M, Igawa S, Yokoba M, Mitsufuji H, Kubota M, Katagiri M, Sasaki J, Naoki K. Prognostic differences between oligometastatic and polymetastatic extensive disease-small cell lung cancer. PLoS One 2019; 14:e0214599. [PMID: 31002722 PMCID: PMC6474590 DOI: 10.1371/journal.pone.0214599] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2018] [Accepted: 03/17/2019] [Indexed: 01/04/2023] Open
Abstract
Purpose Oligometastasis is a state in which cancer patients have a limited number of metastatic tumors; patients with oligometastases survive longer than those with polymetastases. Extensive disease (ED)-small cell lung cancer (SCLC) is considered a systemic disease and a poor survival. This study investigated whether the concept of oligometastases is prognostic factor also applicable to patients with ED-SCLC. Methods We performed a retrospective study of 141 consecutive patients with ED-SCLC between 2008 and 2016. The patients were divided into four subgroups: group 1; patients with solitary metastatic site in one organ (n = 31), group 2; patients with 2–5 metastatic sites in one organ (n = 18), group 3; patients with over 6 metastases in one organ (n = 15), and group 4; patients with 2 or more metastatic organs (n = 77). Results It was identified that 49 patients with ED-SCLC had oligometastases (groups 1 + 2) and 92 had polymetastases (groups 3 + 4). The prognoses of patients with ED-SCLC and oligometastases, defined as ≤5 metastases in a single organ, were significantly superior to those of patients with polymetastases [16.0 (95% CI, 11.0–21.0) months vs. 6.9 (95% CI, 6.0–7.8) months; p<0.001]. 43 of 49 patients with ED-SCLC and oligometastases were relapsed after initial chemotherapy, and 38 (88%) experienced local recurrence. Conclusions Patients with ED-SCLC and oligometastases may have improved survival than those with polymetastases. As oligometastatic ED-SCLC tends to recur locally, local therapy combined with systemic chemotherapy may be a treatment option.
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Affiliation(s)
- Masayuki Shirasawa
- Department of Respiratory Medicine, Kitasato University School of Medicine, Kanagawa, Japan
| | - Tomoya Fukui
- Department of Respiratory Medicine, Kitasato University School of Medicine, Kanagawa, Japan
- * E-mail:
| | - Seiichiro Kusuhara
- Department of Respiratory Medicine, Kitasato University School of Medicine, Kanagawa, Japan
| | - Shinya Harada
- Department of Respiratory Medicine, Kitasato University School of Medicine, Kanagawa, Japan
| | - Noriko Nishinarita
- Department of Respiratory Medicine, Kitasato University School of Medicine, Kanagawa, Japan
| | - Yasuhiro Hiyoshi
- Department of Respiratory Medicine, Kitasato University School of Medicine, Kanagawa, Japan
| | - Mikiko Ishihara
- Department of Respiratory Medicine, Kitasato University School of Medicine, Kanagawa, Japan
| | - Masashi Kasajima
- Department of Respiratory Medicine, Kitasato University School of Medicine, Kanagawa, Japan
| | - Satoshi Igawa
- Department of Respiratory Medicine, Kitasato University School of Medicine, Kanagawa, Japan
| | - Masanori Yokoba
- Department of Medical Laboratory, Kitasato University School of Allied Health Sciences, Kanagawa, Japan
| | - Hisashi Mitsufuji
- Fundamental Nursing, Kitasato University School of Nursing, Kanagawa, Japan
| | - Masaru Kubota
- Department of Respiratory Medicine, Kitasato University School of Medicine, Kanagawa, Japan
| | - Masato Katagiri
- Department of Medical Laboratory, Kitasato University School of Allied Health Sciences, Kanagawa, Japan
| | - Jiichiro Sasaki
- Research and Development Center for New Medical Frontiers, Kitasato University School of Medicine, Kanagawa, Japan
| | - Katsuhiko Naoki
- Department of Respiratory Medicine, Kitasato University School of Medicine, Kanagawa, Japan
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Prognostic Significance of Total Lymphocyte Count, Neutrophil-to-lymphocyte Ratio, and Platelet-to-lymphocyte Ratio in Limited-stage Small-cell Lung Cancer. Clin Lung Cancer 2018; 20:117-123. [PMID: 30611672 DOI: 10.1016/j.cllc.2018.11.013] [Citation(s) in RCA: 39] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2018] [Revised: 11/13/2018] [Accepted: 11/23/2018] [Indexed: 02/07/2023]
Abstract
BACKGROUND We sought reliable markers of survival and disease control among patients treated for limited-stage small-cell lung cancer (LS-SCLC). PATIENTS AND METHODS Subjects were 122 patients given (chemo)radiotherapy for LS-SCLC at MD Anderson in 2002 through 2015. Pretreatment total lymphocyte count (TLC), neutrophil-to-lymphocyte ratio (NLR), and platelet-to-lymphocyte ratio (PLR) were analyzed for associations with overall (OS) and progression-free survival. Optimal cutoff values were identified with receiver operating characteristic curves and survival probabilities with the Kaplan-Meier method. RESULTS Pretreatment TLC was 1.86 × 103/μL (±0.88); NLR, 3.44 (±3.69); and PLR, 170.53 (±101.56); corresponding cutoffs were 1.9, 2.9, and 140.1. Higher TLC was associated with superior median and 2-year OS (17.4 vs. 15.7 months and 33% vs. 29%; P = .029), and higher NLR and PLR with worse median and 2-year OS (NLR: 14.9 vs. 17.8 months, 29% vs. 31%; P = .026; PLR: 14.8 vs. 18.9 months, 24% vs. 37%; P = .009). Multivariate Cox regression adjusted for age, disease stage, number of chemotherapy cycles, and use of prophylactic cranial irradiation confirmed the links between high TLC and superior OS (hazard ratio [HR] 0.55; 95% confidence interval [CI], 0.32-0.94; P = .028) and between high NLR and PLR and inferior OS (NLR: HR, 1.86; 95% CI, 1.15-3.01; P = .011; PLR: HR, 1.72; 95% CI, 1.06-2.82; P = .030). CONCLUSIONS Baseline lymphopenia was an indicator of poor prognosis in patients with LS-SCLC.
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Shirasawa M, Fukui T, Kusuhara S, Hiyoshi Y, Ishihara M, Kasajima M, Nakahara Y, Otani S, Igawa S, Yokoba M, Mitsufuji H, Kubota M, Katagiri M, Sasaki J, Naoki K. Prognostic significance of the 8th edition of the TNM classification for patients with extensive disease small cell lung cancer. Cancer Manag Res 2018; 10:6039-6047. [PMID: 30538553 PMCID: PMC6252783 DOI: 10.2147/cmar.s181789] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
Background Small cell lung cancer (SCLC) is typically categorized according to disease extent as limited or extensive, and utility of the 8th TNM classification, recommended for lung cancer staging, which demonstrates a strong association with non-small-cell lung cancer (NSCLC) management, remains unclear. Methods This retrospective study included 277 consecutive SCLC patients treated at a single institution between 2008 and 2016. Results According to the currently used two-stage system, 186 (65.7%) of the patients were classified as having extensive disease (ED)-SCLC. Among the ED-SCLC patients, ten (5.3%), 38 (20.4%), 32 (17.2%), and 106 (57.0%) were categorized into stages M0, M1a, M1b, and M1c, respectively, according to the 8th TNM classification. There was a significant difference in overall survival based on the M descriptors: 15.8 (95% CI 9.4–22.2) months in the M1b group vs 7.3 (95% CI 5.7–8.9) months in the M1c group (P<0.001). Multivariate analysis showed that in addition to the known prognostic factors such as performance status, serum albumin, and lactate dehydrogenase, M descriptor was a prognostic factor (HR 1.95, 95% CI 1.38–2.77; P<0.001). Conclusion The 8th TNM classification has a prognostic value in SCLC. Similarly to NSCLC, treatment approaches should be considered on the basis of the 8th TNM classification, especially stage IVA separate from stage IVB in ED-SCLC patients.
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Affiliation(s)
- Masayuki Shirasawa
- Department of Respiratory Medicine, Kitasato University School of Medicine, Kanagawa, Japan,
| | - Tomoya Fukui
- Department of Respiratory Medicine, Kitasato University School of Medicine, Kanagawa, Japan,
| | - Seiichiro Kusuhara
- Department of Respiratory Medicine, Kitasato University School of Medicine, Kanagawa, Japan,
| | - Yasuhiro Hiyoshi
- Department of Respiratory Medicine, Kitasato University School of Medicine, Kanagawa, Japan,
| | - Mikiko Ishihara
- Department of Respiratory Medicine, Kitasato University School of Medicine, Kanagawa, Japan,
| | - Masashi Kasajima
- Department of Respiratory Medicine, Kitasato University School of Medicine, Kanagawa, Japan,
| | - Yoshiro Nakahara
- Department of Respiratory Medicine, Kitasato University School of Medicine, Kanagawa, Japan,
| | - Sakiko Otani
- Department of Respiratory Medicine, Kitasato University School of Medicine, Kanagawa, Japan,
| | - Satoshi Igawa
- Department of Respiratory Medicine, Kitasato University School of Medicine, Kanagawa, Japan,
| | - Masanori Yokoba
- Department of Medical Laboratory, Kitasato University School of Allied Health Sciences, Kanagawa, Japan
| | - Hisashi Mitsufuji
- Fundamental Nursing, Kitasato University School of Nursing, Kanagawa, Japan
| | - Masaru Kubota
- Department of Respiratory Medicine, Kitasato University School of Medicine, Kanagawa, Japan,
| | - Masato Katagiri
- Department of Respiratory Medicine, Kitasato University School of Medicine, Kanagawa, Japan,
| | - Jiichiro Sasaki
- Research and Development Center for New Medical Frontiers, Kitasato University School of Medicine, Kanagawa, Japan
| | - Katsuhiko Naoki
- Department of Respiratory Medicine, Kitasato University School of Medicine, Kanagawa, Japan,
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Seigneurin A, Delafosse P, Trétarre B, Woronoff AS, Velten M, Grosclaude P, Guizard AV, Lapôtre-Ledoux B, Bara S, Molinié F, Colonna M. Are comorbidities associated with long-term survival of lung cancer? A population-based cohort study from French cancer registries. BMC Cancer 2018; 18:1091. [PMID: 30419850 PMCID: PMC6233579 DOI: 10.1186/s12885-018-5000-7] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2017] [Accepted: 10/28/2018] [Indexed: 11/10/2022] Open
Abstract
Background Survival rates of lung cancer remains poor and the impact of comorbidities on the prognosis is discussed. The objective of this study was to assess if the Charlson Comorbidity Index (CCI) was associated with 8-year survival rates by histological type. Methods A cohort study was conducted using randomly selected cases from 10 French cancer registries. Net survival rates were computed using the Pohar-Perme estimator of the net cumulative rate. Three Cox models were independently built for adenocarcinomas, squamous cell and small cell cancers to estimate prognostic factors including CCI grade. Results A total of 646 adenocarcinomas, 524 squamous cell and 233 small cell cancers were included in the analysis. The net 8-year survival rate ranged from 12.6% (95% CI: 9.8–15.4%) for adenocarcinomas and 13.4% (95% CI: 10.1–16.7%) for squamous cell carcinomas, to 3.7% (95% CI: 1.1–6.3%) for small cell cancers. Observed and net survival rates decreased for CCI grades ≥3 for all histological group considered. After adjustment for sex, age group, stage and diagnostic mode, CCI grades 1 (HR = 1.6 [95% CI: 1.1–2.3]), 2 (HR = 1.7 [95% CI: 1.1–2.7]) and ≥ 3 (HR = 2.7 [95% CI: 1.7–4.4]) were associated with lower survival rates only for small cell cancers. Conclusion After adjustment for age, sex, stage and diagnostic mode, the presence of comorbidity based on CCI grades 1–2 and ≥ 3 was associated with lower survival rates for small cell cancers whereas no differences were observed for adenocarcinomas and squamous cell cancers.
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Affiliation(s)
- A Seigneurin
- Isère Cancer Registry, CHU Grenoble, Grenoble, France. .,Grenoble Alpes University, Techniques de l'Ingénierie Médicale et de la Complexité - Informatique Mathématiques et Applications Grenoble, Unité Mixte de Recherche 5525, Grenoble, France. .,Medical evaluation unit, CHU Grenoble Alpes, Grenoble, France.
| | - P Delafosse
- Isère Cancer Registry, CHU Grenoble, Grenoble, France
| | - B Trétarre
- Hérault Cancer Registry, Montpellier, France
| | - A S Woronoff
- Doubs Cancer Registry, CHU Besançon, Besançon, France
| | - M Velten
- Bas-Rhin Cancer Registry, Université de Strasbourg, Strasbourg, France
| | - P Grosclaude
- Tarn Cancer Registry, Institut Claudius Regaud, IUCT-O, Registre des cancer du Tarn, Toulouse, France.,, LEASP - UMR 1027 Inserm-Université Toulouse III, Toulouse, France
| | - A V Guizard
- Calvados Cancer Registry, CLCC François Baclesse, Caen, France
| | | | - S Bara
- Manche Cancer Registry, CH du Cotentin, Cherbourg en Cotentin, France
| | - F Molinié
- Loire-Atlantique and Vendée Cancer Registry, CHU Nantes, Nantes, France
| | - M Colonna
- Isère Cancer Registry, CHU Grenoble, Grenoble, France
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Jones GS, McKeever TM, Hubbard RB, Khakwani A, Baldwin DR. Factors influencing treatment selection and 30-day mortality after chemotherapy for people with small-cell lung cancer: An analysis of national audit data. Eur J Cancer 2018; 103:176-183. [PMID: 30261439 DOI: 10.1016/j.ejca.2018.07.133] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2018] [Revised: 07/04/2018] [Accepted: 07/24/2018] [Indexed: 11/16/2022]
Abstract
BACKGROUND Thirty-day mortality after treatment for lung cancer is a measure of unsuccessful outcome and where treatment should have been avoided. Guidelines recommend offering chemotherapy to individuals with small-cell lung cancer (SCLC) who have poorer performance status (PS) because of its high initial response rate. However, this comes with an increased risk of toxicity and early death. We quantified real-world 30-day mortality in SCLC after chemotherapy, established the factors associated with this and compared these with the factors that influence receipt of chemotherapy. METHODS We used linked national English data sets to define the factors associated with both receiving chemotherapy and 30-day mortality after chemotherapy. RESULTS We identified 3715 people diagnosed with SCLC, of which 2235 (60.2%) received chemotherapy. There were 174 (7.8%) deaths within 30 days of chemotherapy. The adjusted odds of receiving chemotherapy decreased with older age, worsening PS and increasing comorbidities. Thirty-day mortality was independently associated with poor PS [PS 2 vs PS 0, adjusted odds ratio (OR) 3.75, 95% confidence interval (CI) 1.71-8.25] and stage (extensive vs limited adjusted OR 1.68, 95% CI 1.03-2.74) but in contrast was not associated with increasing age. Both chemotherapy administration and 30-day mortality varied by hospital network. CONCLUSIONS To reduce variation in chemotherapy administration, predictors of 30-day mortality could be used as an adjunct to improve suboptimal patient selection. We have quantified 30-day mortality risk by the two independently associated factors, PS and stage, so that patients and clinicians can make better informed decisions about the potential risk of early death after chemotherapy.
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Affiliation(s)
- Gavin S Jones
- Division of Epidemiology and Public Health, Clinical Sciences Building, Nottingham, NG5 1PB, UK.
| | - Tricia M McKeever
- Division of Epidemiology and Public Health, University of Nottingham, UK
| | - Richard B Hubbard
- Division of Epidemiology and Public Health, University of Nottingham, UK
| | - Aamir Khakwani
- Division of Epidemiology and Public Health, University of Nottingham, UK
| | - David R Baldwin
- Division of Epidemiology and Public Health, University of Nottingham, UK; Department of Respiratory Medicine, Nottingham University Hospitals, UK
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50
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Bang A, Kendal WS, Laurie SA, Cook G, MacRae RM. Prophylactic Cranial Irradiation in Extensive Stage Small Cell Lung Cancer: Outcomes at a Comprehensive Cancer Centre. Int J Radiat Oncol Biol Phys 2018; 101:1133-1140. [DOI: 10.1016/j.ijrobp.2018.04.058] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2017] [Revised: 04/18/2018] [Accepted: 04/23/2018] [Indexed: 10/17/2022]
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