İlhan Aysegul, Gurler Fatih, Yilmaz Funda, Seyran Erdogan, Bastug Vural, Gorgulu Bugra, Eraslan Emrah, Yıldırım Özgen Ahmet, Yazici Ozan, Çakmak Öksüzoğlu Ömür Berna
Department of Medical Oncology, University of Health Sciences, Dr. Abdurrahman Yurtarslan Ankara Oncology Training and Research Hospital, Ankara, TUR.
Department of Internal Medicine, Gazi University School of Medicine, Ankara, TUR.
Cureus. 2023 Mar 2;15(3):e35710. doi: 10.7759/cureus.35710. eCollection 2023 Mar.
Introduction The geriatric patient population diagnosed with extensive stage small cell lung cancer (SCLC) is underrepresented in clinical studies. We aimed to evaluate the clinicopathological characteristics, first-line treatment patterns and treatment outcomes of patients aged 65 years or older with extensive stage SCLC. Material and methods In this multicenter, retrospective cohort study, patients aged 65 years or older, diagnosed with extensive-stage SCLC, between January 2009 and December 2021 were included. Patients who were under 65 years of age at the time of diagnosis and did not develop progression after curative treatment and patients with a second malignancy were excluded from the study. The clinicopathological characteristics, first-line treatment patterns and treatment outcomes were analyzed. Results A total of 132 patients were included in the study. The median age was 70 years (range:65-91), and 118 (89.4%) patients were male. There were 77 (58.3%) patients with eastern cooperative oncology group (ECOG) performance status (PS) of 0-1. There were 26 (19.7%) patients in the limited stage disease and 106 (80.3%) patients in the extensive stage disease at the time of diagnosis. First-line chemotherapy was given to 86 (65.2%) patients. Of the patients who could not receive treatment, 18 patients (13.6%) due to patient refusal, and 28 patients (21.2%) due to comorbid diseases and poor performance status with organ dysfunctions. The most common treatment regimen used as first-line treatment was cisplatin+etoposide (n=47, 54.7%), and followed by carboplatin+etoposide (n=39, 45.3%). First-line chemotherapy responses were complete response in 4 (4.7%) patients, partial response in 35 (40.7%) patients, stable disease in 13 (15.1%) patients, and progressive disease in 34 (39.5%) patients. The most common grade 3-4 adverse events was neutropenia in 33 (38.4%) patients. Forty nine patients (57.0%) completed the planned first-line treatment. The mPFS was 6.1 months and the mOS was 8.2 months with first-line treatment. We found that ECOG PS status was the most important negative prognostic factor for both PFS and OS. There was no difference between carboplatin+etoposide and cisplatin+etoposide regimens in terms of PFS, OS, adverse events and treatment compliance. Conclusion Thus, it may be an appropriate approach not to give up chemotherapy treatment easily in elderly patients with a diagnosis of extensive stage SCLC. It should be kept in mind that finding factors that might affect the prognosis and tailoring the tretment precisely on case-by-case basis in geriatric cancer patients have an impact on survival.
在临床研究中，被诊断为广泛期小细胞肺癌（SCLC）的老年患者群体代表性不足。我们旨在评估65岁及以上广泛期SCLC患者的临床病理特征、一线治疗模式和治疗结果。
在这项多中心回顾性队列研究中，纳入了2009年1月至2021年12月期间被诊断为广泛期SCLC的65岁及以上患者。诊断时年龄小于65岁且在根治性治疗后未进展的患者以及患有第二种恶性肿瘤的患者被排除在研究之外。分析了临床病理特征、一线治疗模式和治疗结果。
共有132例患者纳入研究。中位年龄为70岁（范围：65 - 91岁），118例（89.4%）患者为男性。东部肿瘤协作组（ECOG）体能状态（PS）为0 - 1的患者有77例（58.3%）。诊断时，局限期疾病患者有26例（19.7%），广泛期疾病患者有106例（80.3%）。86例（65.2%）患者接受了一线化疗。在未接受治疗的患者中，18例（13.6%）因患者拒绝，28例（21.2%）因合并疾病和伴有器官功能障碍的体能状态差。作为一线治疗最常用的治疗方案是顺铂 + 依托泊苷（n = 47，54.7%），其次是卡铂 + 依托泊苷（n = 39，45.3%）。一线化疗反应中，4例（4.7%）患者完全缓解，35例（40.7%）患者部分缓解，13例（15.1%）患者病情稳定，34例（39.5%）患者疾病进展。最常见的3 - 4级不良事件是33例（38.4%）患者出现中性粒细胞减少。49例（57.0%）患者完成了计划的一线治疗。一线治疗的中位无进展生存期（mPFS）为6.1个月，中位总生存期（mOS）为8.2个月。我们发现ECOG PS状态是PFS和OS最重要的负性预后因素。在PFS、OS、不良事件和治疗依从性方面，卡铂 + 依托泊苷方案和顺铂 + 依托泊苷方案之间没有差异。
因此，对于诊断为广泛期SCLC的老年患者，不轻易放弃化疗治疗可能是一种合适的方法。应牢记，在老年癌症患者中寻找可能影响预后的因素并根据具体情况精确调整治疗对生存有影响。
