Twenty-year follow-up study of long-term survival of limited-stage small-cell lung cancer and overview of prognostic and treatment factors.
OBJECTIVE
To predict the long-term survival results of clinical trials earlier than using actuarial methods and to assess the factors predictive of long-term cure in patients with limited-stage small-cell lung cancer.


METHODS
Between 1981 and 1998, 1417 new cases of small-cell lung cancer were diagnosed in Saskatchewan, Canada, of which 244 were limited stage and treated with curative intent. They were followed to the end of February 2002. A parametric lognormal statistical model was retrospectively validated to determine whether long-term survival rates could be estimated several years earlier than is possible using the standard life-table actuarial method.


RESULTS
The survival time of the uncured group followed a lognormal distribution. Four 2-year periods of diagnosis were combined, and patients were followed as a cohort for an additional 2 years. The estimated 10-year cause-specific survival rate was 13% by the lognormal model. The Kaplan-Meier calculation for 10-year cause-specific survival rate was 15% +/- 3%. The data also showed that the absence of mediastinal lymphadenopathy and higher chest radiotherapy dose were significant prognostic factors on multivariate analysis (p < 0.05). Among the 163 patients given prophylactic cranial irradiation, a higher biologically effective dose to the brain did not improve survival or decrease the incidence of brain metastases.


CONCLUSIONS
The lognormal model has been validated for the estimation of survival in patients with limited-stage small-cell lung cancer. A higher biologically effective dose to the brain did not improve survival or decrease the incidence of brain metastases.
Tai
Patricia
P
Department of Oncology, Allan Blair Cancer Center, Saskatchewan Cancer Agency, Regina, SK, Canada. ptai@scf.sk.ca
Tonita
Jon
J
Yu
Edward
E
Skarsgard
David
D
D000465:Algorithms; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use; D001932:Brain Neoplasms / Q000517:prevention & control; D018288:Carcinoma, Small Cell / Q000401:mortality* / Q000473:pathology / Q000532:radiotherapy; D016371:Cranial Irradiation; D005500:Follow-Up Studies; D006801:Humans; D008175:Lung Neoplasms / Q000401:mortality* / Q000473:pathology / Q000532:radiotherapy; D015233:Models, Statistical; D015999:Multivariate Analysis; D011379:Prognosis; D011879:Radiotherapy Dosage; D016879:Salvage Therapy; D012525:Saskatchewan / Q000453:epidemiology; D013223:Statistics as Topic; D015996:Survival Rate