title: Combined small-cell lung carcinoma: An institutional experience.
abstract: BACKGROUND
  The purpose of this study is to determine prognostic factors and survival in patients who present with combined small-cell lung cancer (SCLC).
  
  
  METHODS
  A retrospective review of combined SCLC histology in patients treated between1995-2010 was undertaken. Demographics, diagnostic information, disease characteristics, treatment modality, and survival were captured. Survival estimates were performed using Kaplan Meier analysis. Statistical significance was defined as P < 0.05.
  
  
  RESULTS
  Forty-one patients were identified, and 35 records were available for analysis. Median age at diagnosis was 68 (range 50-85). The study included 20 (57%) women and 15 (43%) men; and 94% had a current or former history of smoking. Histology was SCLC/large cell carcinoma not otherwise specified in 28 (80%), and SCLC/adenocarcinoma or SCLC/squamous cell carcinoma in seven (20%). Cardiac or pulmonary comorbidities were present in 80% of patients, and 24 patients had metastatic disease at presentation. Twenty-eight patients received treatment of chemotherapy (n = 24), cranial radiotherapy (n = 5), or thoracic radiotherapy (n = 7). Staging was as follows: stage I-III (n = 11), stage IV (n = 24). Median survival was 15.4 months (range <1-53 months) and 3.4 months (range <1-21.9 months) for American Joint Committee on Cancer (AJCC) stage I-III and stage IV, respectively. Estimated overall six and 12 month survival was 82%, 55%, 37%, and 17% for stage I-III and stage IV, respectively. An improved overall survival rate was found for patients with an Eastern Cooperative Oncology Group performance status of <2, and no weight loss (P < 0.05).
  
  
  CONCLUSIONS
  Akin to SCLC, advanced stage combined SCLC portends a poor prognosis. Perhaps novel chemotherapeutic drugs or targeted agents may improve outcomes for future patient populations.
authors.affiliation: University of Missouri, School of Medicine Columbia, MO, USA.
authors.forename: Audrey S
authors.initials: AS
authors.lastname: Wallace
authors.affiliation: Division of Hematology and Medical Oncology, University of Missouri, School of Medicine Columbia, MO, USA.
authors.forename: Monika
authors.initials: M
authors.lastname: Arya
authors.affiliation: Department of Pathology and Anatomical Science, University of Missouri, School of Medicine Columbia, MO, USA.
authors.forename: Shellaine R
authors.initials: SR
authors.lastname: Frazier
authors.affiliation: Department of Radiology, University of Missouri, School of Medicine Columbia, MO, USA.
authors.forename: Steven
authors.initials: S
authors.lastname: Westgate
authors.affiliation: Department of Statistics, University of Missouri Columbia, MO, USA.
authors.forename: Zhenyu
authors.initials: Z
authors.lastname: Wang
authors.affiliation: Division of Hematology and Medical Oncology, University of Missouri, School of Medicine Columbia, MO, USA.
authors.forename: Donald
authors.initials: D
authors.lastname: Doll
keywords: Chemotherapy; combined-histology; outcome; radiotherapy; small cell lung cancer