title: Clinical impact of post-progression survival on overall survival in patients with limited-stage disease small cell lung cancer after first-line chemoradiotherapy.
abstract: BACKGROUND
  The effects of first-line chemoradiotherapy on overall survival (OS) may be confounded by subsequent lines of therapy in patients with limited-stage disease small cell lung cancer (LD-SCLC). Therefore, we aimed to determine the relationships between progression-free survival (PFS), post-progression survival (PPS) and OS after first-line chemoradiotherapy in LD-SCLC patients.
  
  
  METHODS
  We retrospectively analyzed 71 LD-SCLC patients with performance status (PS) 0-2 who received first-line chemoradiotherapy and had disease recurrence between September 2002 and March 2013 at Shizuoka Cancer Center (Shizuoka, Japan). We determined the correlation between PFS and OS and between PPS and OS at the individual level. In addition, we performed univariate and multivariate analyses to identify significant prognostic factors of PPS.
  
  
  RESULTS
  OS is more strongly correlated with PPS (Spearman's r = 0.86, R (2) = 0.72, p < 0.05) than PFS (Spearman's r = 0.46, R (2) = 0.38, p < 0.05). In addition, the response to second-line treatments, the presence of distant metastases at recurrence and the number of additional regimens after first-line chemoradiotherapy were significant independent prognostic factors for PPS.
  
  
  CONCLUSIONS
  PPS has more impact on OS than PFS in recurrent LD-SCLC patients with good PS at beginning of the treatment. Moreover, treatments administered after first-line chemoradiotherapy may affect their OS. However, larger multicenter studies are needed to validate these findings.
authors.affiliation: Division of Thoracic Oncology, Shizuoka Cancer Center, Japan; Department of Medicine and Molecular Science, Gunma University Graduate School of Medicine, Japan.
authors.forename: Norimitsu
authors.initials: N
authors.lastname: Kasahara
authors.affiliation: Division of Thoracic Oncology, Shizuoka Cancer Center, Japan; Department of Medicine and Molecular Science, Gunma University Graduate School of Medicine, Japan.
authors.forename: Hisao
authors.initials: H
authors.lastname: Imai
authors.affiliation: Division of Thoracic Oncology, Shizuoka Cancer Center, Japan; Department of Oncology Clinical Development, Gunma University Graduate School of Medicine, Japan.
authors.forename: Kyoichi
authors.initials: K
authors.lastname: Kaira
authors.affiliation: Clinical Trial Coordination Office, Shizuoka Cancer Center, Japan.
authors.forename: Keita
authors.initials: K
authors.lastname: Mori
authors.affiliation: Division of Thoracic Oncology, Shizuoka Cancer Center, Japan.
authors.forename: Kazushige
authors.initials: K
authors.lastname: Wakuda
authors.affiliation: Division of Thoracic Oncology, Shizuoka Cancer Center, Japan.
authors.forename: Akira
authors.initials: A
authors.lastname: Ono
authors.affiliation: Division of Thoracic Oncology, Shizuoka Cancer Center, Japan.
authors.forename: Tetsuhiko
authors.initials: T
authors.lastname: Taira
authors.affiliation: Division of Thoracic Oncology, Shizuoka Cancer Center, Japan.
authors.forename: Hirotsugu
authors.initials: H
authors.lastname: Kenmotsu
authors.affiliation: Division of Radiation Oncology, Shizuoka Cancer Center, Japan.
authors.forename: Hideyuki
authors.initials: H
authors.lastname: Harada
authors.affiliation: Division of Thoracic Oncology, Shizuoka Cancer Center, Japan.
authors.forename: Tateaki
authors.initials: T
authors.lastname: Naito
authors.affiliation: Division of Thoracic Oncology, Shizuoka Cancer Center, Japan.
authors.forename: Haruyasu
authors.initials: H
authors.lastname: Murakami
authors.affiliation: Division of Diagnostic Radiology, Shizuoka Cancer Center, Japan.
authors.forename: Masahiro
authors.initials: M
authors.lastname: Endo
authors.affiliation: Division of Diagnostic Pathology, Shizuoka Cancer Center, Japan.
authors.forename: Takashi
authors.initials: T
authors.lastname: Nakajima
authors.affiliation: Department of Medicine and Molecular Science, Gunma University Graduate School of Medicine, Japan.
authors.forename: Masanobu
authors.initials: M
authors.lastname: Yamada
authors.affiliation: Division of Thoracic Oncology, Shizuoka Cancer Center, Japan.
authors.forename: Toshiaki
authors.initials: T
authors.lastname: Takahashi
keywords: chemoradiotherapy; limited-stage disease small cell lung cancer; overall survival; post-progression survival; progression-free survival
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