Survival of Patients with Small Cell Lung Carcinoma in Taiwan

Abstract

Background: Small cell lung cancer (SCLC) is the most aggressive form of lung cancer. The prognosis for SCLC patients remains unsatisfactory despite advances in chemotherapy. In this study, we sought to clarify the prognosis and treatment patterns of patients with SCLC. Methods: A cohort comprising all patients diagnosed with SCLC between January 2004 and December 2006 was assembled from the Taiwan Cancer Database. Patients were followed up until December 31, 2009, to determine overall survival. Patient survival was estimated using the Kaplan-Meier method, and Cox’s proportional hazard model was used to determine the relationship between prognostic factors and median survival time. Results: Among the 1,684 patients diagnosed with SCLC, 1,215 (72%) were diagnosed with extensive-stage disease and 469 (28%) with limited-stage disease. Most of the patients were male (90%). The median survival duration of patients with limited-stage and extensive-stage SCLC was 10.3 months and 5.6 months, respectively. For limited-stage patients, surgery, chemotherapy, and combined chemotherapy and radiotherapy resulted in better survival than best supportive care (HR 0.20, p < 0.001; HR 0.61, p < 0.001, and HR 0.37, p < 0.001, respectively). For extensive-stage patients, male gender was significantly associated with a poor prognosis (HR 1.45, p < 0.001) and chemotherapy was shown to improve overall survival more effectively than best supportive care (HR 0.37, p < 0.001). Conclusion: For limited-stage SCLC patients, surgery, chemotherapy, and combined chemotherapy and radiotherapy improved survival compared to best supportive care. Extensive-stage SCLC patients benefited more from chemotherapy treatment than from best supportive care.

Role of surgery in the management and prognosis of limited-stage small cell carcinoma of the esophagus

“…Situ and colleagues reported that the presence of metastases in multiple regional lymph nodes was associated with a worse prognosis . These data support the hypothesis that the success of limited‐stage SCCE therapy depends on the stage and type of tumor, which is similar to findings in small cell lung cancer (SCLC) …”

“…Kuo and colleagues reported that two of eight patients with limited‐stage SCCE received chemotherapy as their sole treatment. Partial responses were induced in these two patients; however, disseminated disease appeared rapidly, and they only survived for 15 and 20 months, respectively . Medgyesy and colleagues found that the long‐term survival of patients was lower after chemoradiotherapy because of fewer pathological complete responses in combined‐type SCCE .…”

“…15 These data support the hypothesis that the success of limitedstage SCCE therapy depends on the stage and type of tumor, which is similar to findings in small cell lung cancer (SCLC). 24,25 The effect of surgical treatment is controversial; however, surgical resection was frequently the first choice for patients with limited-stage SCCE in previous studies, 20,21 because several patients were pathologically diagnosed with squamous cell carcinoma before surgery. Furthermore, patients may need surgical resection to relieve symptoms due to an obstruction of the esophagus.…”

“…Partial responses were induced in these two patients; however, disseminated disease appeared rapidly, and they only survived for 15 and 20 months, respectively. 24 Medgyesy and colleagues found that the long-term survival of patients was lower after chemoradiotherapy because of fewer pathological complete responses in combined-type SCCE. 27 These data indicate that surgery has an important role in the treatment of SCCE.…”

Mosquito coil exposure associated with small cell lung cancer: A report of three cases

“…The majority of patients with SCLC are extensive-stage at the time of initial diagnosis, where the cancer has spread either to the other side of the chest or to more distant locations in the body. The median survival rates are 10.3 months and 5.6 months for patients with limited- and extensive-stage disease, respectively (7). …”