Division of Pulmonology, Department of Internal Medicine, Pohang Semyeong Christianity Hospital, Pohang, Republic of Korea.
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.
J Cancer Res Clin Oncol. 2023 Aug;149(10):7275-7283. doi: 10.1007/s00432-023-04686-2. Epub 2023 Mar 13.
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.
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.
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).
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.
肺功能差和慢性阻塞性肺疾病（COPD）与非小细胞肺癌（NSCLC）患者的整体生存率（OS）较差相关。很少有研究调查小细胞肺癌（SCLC）患者的肺功能与 OS 之间的关系。我们比较了广泛期小细胞肺癌（ED-SCLC）中弥散量中度受损（DLco）的患者与无弥散量中度受损的患者的临床特征，并探讨了 ED-SCLC 患者生存相关的因素。
这是一项回顾性单中心研究，于 2011 年 1 月至 2020 年 12 月进行。在研究期间接受癌症治疗的 307 例 SCLC 患者中，有 142 例 ED-SCLC 患者进行了分析。患者分为 DLco<60%组和 DLco≥60%组。分析 OS 和不良 OS 的预测因素。
142 例 ED-SCLC 患者的中位 OS 为 9.3 个月，中位年龄为 68 岁。共有 129 例（90.8%）患者有吸烟史，60 例（42.3%）患有 COPD。35 例（24.6%）患者被分到 DLco<60%组。多因素分析显示，DLco<60%（比值比[OR]，1.609；95%置信区间[CI]，1.062-2.437；P=0.025）、转移灶数量（OR，1.488；95%CI，1.262-1.756；P<0.001）和一线化疗<4 个周期（OR，3.793；95%CI，2.530-5.686；P<0.001）与不良 OS 相关。40 例（28.2%）患者接受<4 个周期的一线化疗；最常见的原因是因 4 级发热性中性粒细胞减少症（n=15）、感染（n=5）或大咯血（n=2）导致的死亡。DLco<60%组的中位 OS 短于 DLco≥60%组（10.6±0.8 个月 vs. 4.9±0.9 个月，P=0.003）。
在这项研究中，大约四分之一的 ED-SCLC 患者存在 DLco<60%。低 DLco（而非 1 秒用力呼气量或用力肺活量）、大量转移灶和一线化疗<4 个周期是 ED-SCLC 患者生存不良的独立危险因素。
