Real-world predictors of survival in patients with limited-stage small-cell lung cancer in Manitoba, Canada.

Background

Although therapy for limited-stage small-cell lung cancer (LS-SCLC) is administered with curative intent, most patients relapse and eventually die of recurrent disease. Chemotherapy (CT) with concurrent radiotherapy (RT) remains the standard of care for LS-SCLC; however, this could evolve in the near future. Therefore, understanding the current prognostic factors associated with survival is essential.

Objective

This real-world analysis examines factors associated with long-term survival in patients with LS-SCLC treated with CT in Manitoba, Canada.

Methods

A retrospective cohort study was conducted using Manitoba Cancer Registry and CancerCare Manitoba records. Eligible patients were aged >18 years and had cytologically confirmed LS-SCLC diagnosed between January 1, 2004, and December 31, 2018, for which they received CT ± RT. Baseline patient, disease, and treatment characteristics and survival duration, characterized as short (<6 months), medium (6-24 months), and long term (>24 months), were extracted. Overall survival (OS) was estimated at one, two, and five years and assessed using Kaplan-Meier methods and Cox proportional hazards models.

Results

Over the 15-year study period, 304 patients met the eligibility criteria. Long-term survivors comprised 39.1% of the cohort; at diagnosis, this subgroup was younger, more likely to have Eastern Cooperative Oncology Group Performance Status (ECOG PS) 0, and have normal lactate dehydrogenase, sodium, and hemoglobin levels. OS estimates for the entire cohort at one, two, and five years were 66%, 38%, and 18%, respectively. In the ECOG PS 0 subgroup, OS estimates at one, two, and five years were 85%, 52%, and 24%, respectively; OS estimates were 60%, 35%, and 17%, respectively, for ECOG PS 1-2 and were 47%, 23%, and 10%, respectively, for ECOG PS 3-4. OS was significantly higher among patients with normal serum sodium and hemoglobin levels than those with abnormal levels. Univariable hazard regression models found that ECOG PS, age at diagnosis, receipt of prophylactic cranial irradiation (PCI), and thoracic RT were associated with survival. On multivariable hazard regression, ECOG PS and receipt of PCI were associated with survival.

Conclusion

Survival for greater than two years in patients with LS-SCLC treated with CT ± RT was associated with ECOG PS and receipt of PCI.

Informations de copyright

Copyright © 2023 Dawe, Rittberg, Syed, Shanahan, Moldaver, Bucher, Galloway, Reynolds, Paul, Harlos, Kim and Banerji.

Déclaration de conflit d'intérêts

DD reports advisory board attendance for Merck Canada, Novartis, Jazz Pharmaceuticals, Pfizer, and AstraZeneca, honoraria for education content from Boehringer-Ingelheim and Bristol Myers Squibb, grants from Canadian Institutes of Health Research, CancerCare Manitoba Foundation, Manitoba Medical Services Foundation, and a research grant for this project from AstraZeneca. RR reports grant funding received from AstraZeneca. SB reports advisory board attendance for AstraZeneca, Bayer, Bristol Myers Squibb, Jazz Pharmaceuticals, Merck Canada, Novartis Janssen, Pfizer, and Roche, clinical trial funding from AstraZeneca, Bayer, and Roche, grants from Canadian Institutes of Health Research, grants from CancerCare Manitoba Foundation, grants from Genome Canada, outside the submitted work. IS and MS are employees and shareholders of AstraZeneca. DM was an employee of AstraZeneca at the time of this study. The remaining authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.