Department of Thoracic Oncology II, Peking University Cancer Hospital & Institute, Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Beijing, China.
Thorac Cancer. 2021 Jun;12(12):1841-1850. doi: 10.1111/1759-7714.13846. Epub 2021 May 6.
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.
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.
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.
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.
小细胞肺癌（SCLC）具有侵袭性扩散和预后不良的特点，但治疗选择有限。关于治疗方案的随机试验中预后因素的结果存在冲突，并且缺乏大规模的真实世界分析。
本研究纳入了 2008 年至 2018 年期间在北京大学肿瘤医院就诊的 SCLC 患者。采用 Kaplan-Meier 方法，构建单因素分析和多因素 Cox 回归模型，分析预后因素。
在就诊于我们中心的 1045 例患者中，有 988 例符合条件的患者被确定。全组患者的中位总生存期（OS）为 16.0 个月，局限期小细胞肺癌（LS-SCLC）和广泛期小细胞肺癌（ES-SCLC）患者的 OS 分别为 24.0 个月和 11.0 个月。局限期、较好的体能状态（PS）（ECOG 0-1）、对原发系统性治疗的反应，以及接受主动照射和三线或以上化疗的患者，在全组中预测有更好的 OS。只有一线系统性治疗反应和预防性颅脑照射（PCI）是 LS-SCLC 生存的独立预后因素；而 PS 较好（ECOG 0-1）、无肝、骨或皮下转移、一线治疗反应、初始局部照射和三线或以上系统治疗预测 ES-SCLC 预后良好。
本研究从大量真实世界数据中发现，原发系统性治疗反应和积极的放疗是 SCLC 的独立预后因素。PCI 和对原发病灶或转移灶的主动照射分别提高了 LS-SCLC 和 ES-SCLC 的 OS。
