Erciyestepe Mert, Ekinci Ömer Burak, Doğan Hale Gülçin Yıldırım, Öztürk Ahmet Emin, Aydın Okan, Büyükkuşcu Aslı, Atasever Tugay, Uslu Beyza Soylu, Akkaya Kübra, Çelik Emir, Ertürk Kayhan, Atcı Muhammed Mustafa
Department of Medical Oncology, Sağlık Bilimleri University, Prof. Dr. Cemil Taşcıoğlu City Hospital, Darülaceze Cad. No:27, İstanbul, Turkey.
BMC Pulm Med. 2025 Apr 8;25(1):160. doi: 10.1186/s12890-025-03625-w.
Although chemotherapy significantly improves the quality of life and prolongs survival in patients with extensive-stage small cell lung cancer (ES-SCLC), relapse is almost inevitable, with only 5% of patients surviving two years after the initial diagnosis. Prophylactic cranial irradiation (PCI) is considered for patients who achieve a complete response, as it has been shown to improve survival rates in this population. Recent studies have also demonstrated that adding PD-L1 inhibitors, such as atezolizumab or durvalumab, to chemotherapy in first-line treatment significantly enhances survival compared to chemotherapy alone. Our study was conducted retrospectively at a single center, including 280 patients with ES-SCLC who began therapy at our institution between July 2009 and February 2023. Patients who underwent thoracic residual radiotherapy (p< 0.001) and PCI (p< 0.001) showed statistically significant improvements in OS. In the first-line treatment group, the median overall survival (OS) for patients receiving cisplatin+etoposide was 12.0 months (10.71 - 13.28), while those treated with carboplatin+etoposide had a median OS of 7.0 months (4.58 - 9.41). For patients receiving carboplatin+etoposide+atezolizumab, the median OS was 35.0 months (21.32 - 48.67), and a statistically significant difference was observed (p< 0.001). In our study, the median OS was 7 months in patients who received ≤ 4 cycles of treatment in the first line and 14 months in patients who received > 4 cycles of treatment. After first-line treatment, the proportion of patients with progression-free survival (PFS) between 0 - 3 months was 21%, and between 3 - 6 months was 24%. PFS was notably worse in those with bone, liver, or brain metastases at diagnosis in the first-line treatment. Multivariate analysis revealed that carboplatin+etoposide+atezolizumab in the first line and cisplatin+etoposide in the second line reduced the risk of both progression and death, while PCI reduced the risk of death. In conclusion, ES-SCLC remains one of the most challenging malignancies, characterized by poor survival rates and short progression-free intervals. Multiple factors influence OS and PFS, some of which are intrinsic to the patient and disease at diagnosis. In contrast, others, such as treatment modalities, the number of treatment cycles, and the application of radiotherapy, can be modified by clinicians.
尽管化疗显著提高了广泛期小细胞肺癌（ES-SCLC）患者的生活质量并延长了生存期，但复发几乎不可避免，初诊后仅有5%的患者能存活两年。对于达到完全缓解的患者，可考虑进行预防性脑照射（PCI），因为已证明这能提高该人群的生存率。最近的研究还表明，在一线治疗中，将阿替利珠单抗或度伐利尤单抗等PD-L1抑制剂添加到化疗中，与单纯化疗相比，能显著提高生存率。我们的研究是在单一中心进行的回顾性研究，纳入了2009年7月至2023年2月期间在我们机构开始治疗的280例ES-SCLC患者。接受胸部残留放疗（p<0.001）和PCI（p<0.001）的患者总生存期（OS）有统计学意义的显著改善。在一线治疗组中，接受顺铂+依托泊苷的患者中位总生存期（OS）为12.0个月（10.71 - 13.28），而接受卡铂+依托泊苷治疗的患者中位OS为7.0个月（4.58 - 9.41）。接受卡铂+依托泊苷+阿替利珠单抗的患者中位OS为35.0个月（21.32 - 48.67），差异有统计学意义（p<0.001）。在我们的研究中，一线接受≤4个周期治疗的患者中位OS为7个月，接受>4个周期治疗的患者中位OS为14个月。一线治疗后，无进展生存期（PFS）在0 - 3个月的患者比例为21%，在3 - 6个月的患者比例为24%。在一线治疗中诊断时有骨、肝或脑转移的患者PFS明显更差。多因素分析显示，一线使用卡铂+依托泊苷+阿替利珠单抗和二线使用顺铂+依托泊苷可降低进展和死亡风险，而PCI可降低死亡风险。总之，ES-SCLC仍然是最具挑战性的恶性肿瘤之一，其特点是生存率低和无进展间期短。多种因素影响OS和PFS，其中一些是诊断时患者和疾病的内在因素。相比之下，其他因素，如治疗方式、治疗周期数和放疗的应用，可由临床医生进行调整。
