Background. The effects of first-line chemotherapy on overall survival (OS) might be confounded by subsequent therapies in patients with small-cell lung cancer (SCLC). Therefore, by using individual-level data, we aimed to determine the relationships between progression-free survival (PFS) or postprogression survival (PPS) and OS after first-line chemotherapies in patients with extensive disease-SCLC (ED-SCLC) treated with carboplatin plus etoposide. Methods. Between July 1998 and December 2014, we analyzed 63 cases of patients with ED-SCLC who were treated with carboplatin and etoposide as first-line chemotherapy. The relationships of PFS and PPS with OS were analyzed at the individual level. Results. Spearman rank correlation analysis and linear regression analysis showed that PPS was strongly correlated with OS (r = 0.90, p < 0.05, and R 2 = 0.71) and PFS was moderately correlated with OS (r = 0.72, p < 0.05, and R 2 = 0.62). Type of relapse (refractory/sensitive) and the number of regimens administered after disease progression after the first-line chemotherapy were both significantly associated with PPS (p < 0.05). Conclusions. PPS has a stronger relationship with OS than does PFS in ED-SCLC patients who have received first-line chemotherapy. These results suggest that treatments administered after first-line chemotherapy affect the OS of ED-SCLC patients treated with carboplatin plus etoposide.

BackgroundThe effects of first‐line chemotherapy on overall survival (OS) might be confounded by subsequent therapies in patients with small‐cell lung cancer (SCLC). Therefore, the objective of our study was to determine the relationships between progression‐free survival (PFS) or post‐progression survival (PPS) and OS after first‐line chemotherapy in elderly patients with extensive disease‐SCLC (ED‐SCLC), using individual level data.MethodsBetween July 1998 and December 2014, we analyzed 57 cases of elderly patients with ED‐SCLC who were treated with carboplatin and etoposide as first‐line chemotherapy. The relationships between PFS and PPS with OS were analyzed at an individual level.ResultsSpearman rank correlation and linear regression analyses showed that PPS was strongly correlated with OS (r = 0.92, P < 0.05, R 2 = 0.83) and PFS was moderately correlated with OS (r = 0.76, P < 0.05, R 2 = 0.25). The best response at second‐line treatment and the number of regimens after progression beyond first‐line chemotherapy were both significantly associated with PPS (P < 0.05).Conclusions PPS has a stronger impact on OS than PFS in elderly ED‐SCLC patients after first‐line chemotherapy. In addition, the response at second‐line treatment and the number of additional regimens after first‐line treatment are significant independent prognostic factors for PPS. These results suggest that OS in elderly ED‐SCLC patients may be influenced by treatments subsequent to first‐line chemotherapy; however, this remains to be verified with prospective studies.

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factors associated with treatment refusal by SCLC patients and effect of refusal on survival. Methods: We analyzed data of 114,004 SCLC patients diagnosed between 2003 and 2012 from the National Cancer Data Base. Analyses were conducted separately for refusal of chemoradiotherapy among limited stage (LS) and refusal of chemotherapy among extensive stage (ES) patients. We used multivariable logistic regression to investigate factors associated with treatment refusal and calculated median survival using Kaplan-Meier method. Results: There was a female preponderance among LS (56%), whereas 52% of ES patients were male (p <.001). Majority of the LS patients received chemoradiotherapy (67%), and ES patients received chemotherapy only (44%) as their first-course treatment. Refusal of chemoradiotherapy among LS patients was 2%, and refusal of chemotherapy among ES patients was 5%. On multivariable analysis, patient diagnosed at age >70 years were more likely to refuse treatment compared to those age 50-70 years; the adjusted odds ratio (AOR) was 3.39 (95% CI: 2.68-4.28) for refusal of chemoradiotherapy among LS patients and 2.54 (95% CI: 2.28-2.84) for refusal of chemotherapy among ES patients. Females were more likely to refuse recommended treatment than males, the AOR was 1.34 (95% CI: 1.09-1.65) for refusal of chemoradiotherapy and 1.29 (95% CI: 1.17-1.42) for refusal of chemotherapy. Compared to those with private insurance, uninsured patients were more likely to refuse chemoradiotherapy (AOR¼ 2.70, 95% CI: 1.49-4.91) and chemotherapy (AOR¼2.26, 95% CI: 1.76-2.91). Patients with comorbid conditions were more likely to refuse recommended treatment compared to those without comorbidity; the AOR was 1.66 (95% CI: 1.33-2.07) for refusal of chemoradiotherapy and 1.37 (95% CI: 1.23-1.53) for refusal of chemotherapy. Median survival of LS patients who received and refused chemoradiotherapy was 18 and 3 months respectively (p <.001). Among ES patients, median survival was 8 months for those who received chemotherapy and 1 month for those who refused (p <.001). Conclusion: Although treatment refusal was uncommon, older age at diagnosis, female, uninsured status, and comorbid conditions were associated with higher treatment refusal. These factors should be specially addressed in patient-provider communication and patient-education. Interventions targeting these issues will increase acceptance of recommended treatment and ultimately will improve patient outcomes.

Background: The benefits of second-line chemotherapy on the overall survival (OS) of small-cell lung cancer (SCLC) patients might be confounded by subsequent therapies. In this study, we aimed to determine the influence of progression-free survival (PFS) and of postprogression survival (PPS) on OS after second-line chemotherapy in patients with refractory SCLC treated with amrubicin monotherapy. Method: We analyzed the data of 35 patients with refractory SCLC who were treated with amrubicin monotherapy as second-line chemotherapy between July 2005 and December 2015. The correlations of PFS and PPS with OS were statistically analyzed at the individual level using Spearman rank correlation and linear regression analyzes. Result: The correlation between PPS and OS was strong (r ¼ 0.88, p <0.05, R 2 ¼ 0.87), while that between PFS and OS was weak (r ¼ 0.60, p <0.05, R 2 ¼ 0.15). The number of regimens administered after disease progression post-second-line chemotherapy was significantly associated with PPS (p ¼ 0.003). Conclusion: OS is more strongly linked to PPS than to PFS in refractory SCLC patients who undergo amrubicin monotherapy as a second-line treatment. Moreover, receiving additional regimens after second-line treatment is a significant independent prognostic factor for PPS. Taken together, our results indicate that additional treatments administered after second-line chemotherapy favorably affect the OS of refractory SCLC patients treated with amrubicin monotherapy.