title: Selected patients can benefit more from the management of etoposide and platinum-based chemotherapy and thoracic irradiation-a retrospective analysis of 707 small cell lung cancer patients.
abstract: The management of small cell lung cancer (SCLC) has reached a plateau. Etoposide and platinum-based chemotherapy plus thoracic irradiation remain the standard treatment strategy for SCLC. Our study aims to assess the potential prognostic factors of patients treated with etoposide and platinum-based chemotherapy and explore which group of patients can benefit more from standard treatment strategies. On univariate analysis, age>65 years, male patients, KPS (Karnofsky Performance Status)≤80 points, positive smoking history, anemia, lymphocyte counts≤1.65×109/L, neutrophil to lymphocyte ratio (NLR)>3.18, lymphocyte to monocyte ratio (LMR)≤2.615, lactate dehydrogenase (LDH)>216.5 U/L, alkaline phosphatase (ALP)>119.5 U/L, absence of surgery, absence of thoracic irradiation, chemotherapy cycles<4, metastatic sites≥2 and extensive disease were correlated with a poor prognosis. Gender, KPS, chemotherapy cycles, thoracic irradiation, metastatic sites, LDH and tumor stage held statistical significance on multivariate analysis (p<0.05). High LDH was closely correlated with extensive disease, metastatic sites≥2, anemia, low LMR, high NLR and ALP levels. Subgroup analysis showed patients with male gender, KPS≤80 points, LDH≤216.5U/L, extensive disease and metastatic sites<2 could benefit more from ≥4 chemotherapy cycles. Patients with male gender, KPS>80 points, LDH≤216.5U/L, limited disease and metastatic sites<2 could benefit more from thoracic irradiation (p<0.05 on uni- and multivariate analysis). In conclusion, female patients, KPS>80 points, chemotherapy cycles≥4, thoracic irradiation, metastatic sites<2, LDH≤216.5U/L and limited disease were independent positive prognostic factors for SCLC patients treated with etoposide and platinum-based chemotherapy. Selected patients can benefit more from the management of ≥4 cycles of chemotherapy and thoracic irradiation.
authors.affiliation: Department of Medical Oncology, Harbin Medical University Cancer Hospital, Harbin, China.
authors.forename: Shoubo
authors.initials: S
authors.lastname: Cao
authors.affiliation: Department of Medical Oncology, Harbin Medical University Cancer Hospital, Harbin, China.
authors.forename: Shi
authors.initials: S
authors.lastname: Jin
authors.affiliation: Department of Medical Oncology, Harbin Medical University Cancer Hospital, Harbin, China.
authors.forename: Jing
authors.initials: J
authors.lastname: Shen
authors.affiliation: Department of Medical Oncology, Harbin Medical University Cancer Hospital, Harbin, China.
authors.forename: Jingyan
authors.initials: J
authors.lastname: Cao
authors.affiliation: Department of Medical Oncology, Harbin Medical University Cancer Hospital, Harbin, China.
authors.forename: Hua
authors.initials: H
authors.lastname: Zhang
authors.affiliation: Department of Medical Oncology, Harbin Medical University Cancer Hospital, Harbin, China.
authors.forename: Qingwei
authors.initials: Q
authors.lastname: Meng
authors.affiliation: Department of Medical Oncology, Harbin Medical University Cancer Hospital, Harbin, China.
authors.forename: Chunyan
authors.initials: C
authors.lastname: Wang
authors.affiliation: Department of Medical Oncology, Harbin Medical University Cancer Hospital, Harbin, China.
authors.forename: Aiqi
authors.initials: A
authors.lastname: Zhang
authors.affiliation: Department of Medical Oncology, Harbin Medical University Cancer Hospital, Harbin, China.
authors.forename: Pei
authors.initials: P
authors.lastname: Zhang
authors.affiliation: Department of Medical Oncology, Harbin Medical University Cancer Hospital, Harbin, China.
authors.forename: Yan
authors.initials: Y
authors.lastname: Yu
mesh_terms: D000328:Adult; D000368:Aged; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000009:adverse effects / Q000627:therapeutic use*; D014408:Biomarkers, Tumor / Q000097:blood; D002289:Carcinoma, Non-Small-Cell Lung / Q000097:blood / Q000556:secondary / Q000628:therapy*; D059248:Chemoradiotherapy / Q000009:adverse effects; D005047:Etoposide / Q000008:administration & dosage* / Q000009:adverse effects; D005260:Female; D006801:Humans; D017567:Karnofsky Performance Status; D008175:Lung Neoplasms / Q000097:blood / Q000473:pathology / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D018579:Patient Selection; D017671:Platinum Compounds / Q000008:administration & dosage* / Q000009:adverse effects; D012189:Retrospective Studies; D012307:Risk Factors; D012737:Sex Factors; D013997:Time Factors; D016896:Treatment Outcome; D055815:Young Adult
chemical_list: D014408:Biomarkers, Tumor; D017671:Platinum Compounds; D005047:Etoposide
keywords: inflammation; prognostic factors; small cell lung cancer; subgroup analysis; survival