Comparison of treatment strategies for patients with limited-stage small cell lung cancer who received chemotherapy

Wei, Shen; Wei, Bo; Tian, Jintao; Song, Xiaoping; Wu, Bingquan; Hu, Pengcheng

doi:10.21037/tcr.2019.12.13

Cited by 2 publications

(7 citation statements)

References 22 publications

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“…[ 24 , 38 , 39 , 56 ] An OS benefit favoring surgery compared with treatment with CT and/or RT was observed in patients in stage I to II (median: 31–34 vs 23–24 months, P < .001), [ 34 , 35 ] stage I to III (26-not reached vs 6 months, P < .001), [ 33 ] and stage IIB–IIIC SCLC (20 vs 14 months, P < .001), [ 36 ] as well as in patients (stage I–III) with no evidence of receipt of CT ( P < .001, all). [ 38 ] Surgery with CT/CRT conferred a significant survival advantage compared with CT/CRT alone (median OS: 18–79 vs 12–23 months, P < .05, all), [ 29 , 39 , 40 , 56 ] and relative to palliative CT or RT (40.2 vs 10.7 months, P < .001) [ 56 ] in stage I to III SCLC. Surgery did not result in a significant survival advantage in patients with stage II to III SCLC [ 32 ] or in subgroups with stage IIIB or IIIC.…”

Section: Resultsmentioning

confidence: 99%

“…1). Twenty-five publications reported outcomes data for limited stage, [17–41] 13 for extensive stage, [42–54] and 2 for both. [55,56] All studies examined OS as the primary outcome.…”

Section: Resultsmentioning

confidence: 99%

“…The most commonly used statistical methods included Cox proportional hazard models. [17][18][19]23,[25][26][27][28]30,31,[33][34][35][36]38,39,41,55,56] Matching with propensity scores [17,29,31,35,57] or alternate methods [32] were used in 6 publications. Five studies did not use any statistical adjustment of outcomes, [20][21][22]24,40] of which only 2 reported that groups were balanced with respect to baseline characteristics.…”

Section: Study Characteristics and Quality Assessmentmentioning

confidence: 99%

“…Among the studies enrolling patients with stage I to III disease, the proportion undergoing surgery was 4.2% to 10.8%. [24,38,39,56] An OS benefit favoring surgery Wei, 2020 (US) [39] Surgery + RT ± CT --(32-NR) 85.2 (78.3-92) 43 Kim, 2017 (US)* [33] ; Jin, 2018 (US) [34] Surgery + CT 38.6 (18-79) 91 (70-100) 35.3 (28-45) Wei, 2020 (US) [39] ; Elegbede, 2020 (Canada) [56] ; Zhong, 2020 (China) [40] ; Takenaka (Japan) [29] Surgery without RT ± CT 32 (26-37.1) 82 (75-87) 42 (39-45) Kim, 2017 (US) [33] ; Jin, 2018 (US) [34] ; Chen, 2019 (China) [32] Surgery + CT and/or RT 25.5 (20)(21)(22)(23)(24)(25)(26)(27)(28)(29)(30)(31) 73.9 (67.8-80) 34.0 (30-38) Yang, 2019 (US), [36] Wang, 2020 (US) [35] Wei, 2020 (US) [39] ; Elegbede, 2020 (Canada) [56] ; Chen, 2019 (China) [32] ; Zhong, 2020 (China) [40] ; Pezzi, 2018 (US) [25] ; Corso, 2015 (US) [17] ; Ohara, 2018 (Japan) [24] QD CRT 27.8 (26-29.5) 90 20.7 (13.3-28.0) Han, 2015 (China) [21] ; Damhuis, 2018 (the Netherlands) † [18] [21] ; Damhuis, 2018 (the Netherlands) † [18] Sequential CRT 17.5 80 (80-80) 19 (16-42) Damhuis, 2018 (the Netherlands) † [18] ; Manapov, 2016 (Germany) <...…”

Section: Outcomes Of Limited-stage Sclcmentioning

confidence: 99%

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A systematic literature review of real-world treatment outcomes of small cell lung cancer

et al. 2022

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Background: Robust evidence from real-world studies is needed to aid decision-makers and other stakeholders in choosing the best treatment options for patients. The objective of this work was to assess real-world outcomes of treatment strategies for limited-and extensive-stage small cell lung cancer (SCLC) prior to the global introduction of immunotherapies for this disease.Methods: Searches were conducted in MEDLINE and Embase to identify articles published in English from October 1, 2015, through May 20, 2020. Searches were designed using a combination of Medical Subject Heading (Medline), Emtree (Embase subject headings), and free-text terms such as SCLC. Observational studies reporting data on outcomes of initial treatment strategies in patients with limited-and extensive-stage SCLC were included. Studies with limited sample sizes (<100 patients), enrolled all patients prior to 2010, or did not report outcomes for limited-and extensive-stage SCLC separately were excluded. Data were extracted into a predesigned template by a single researcher. All extractions were validated by a second researcher, with disagreements resolved via consensus.Results: Forty articles were included in this review. Most enrolled patients from the United States (n = 18 articles) or China (n = 12 articles). Most examined limited-stage (n = 27 articles) SCLC. All studies examined overall survival as the primary outcome. Articles investigating limited-stage SCLC reported outcomes for surgery, chemotherapy and/or radiotherapy, and adjuvant prophylactic cranial irradiation. In studies examining multiple treatment strategies, chemoradiotherapy was the most commonly utilized therapy (56%-82%), with chemotherapy used in 18% to 44% of patients. Across studies, median overall survival was generally higher for chemoradiotherapy (15-45 months) compared with chemotherapy alone (6.0-15.6 months). Studies of extensive-stage SCLC primarily reported on chemotherapy alone, consolidative thoracic radiotherapy, and radiotherapy for patients presenting with brain metastases. Overall survival was generally lower for patients receiving chemotherapy alone (median: 6.4-16.5 months; 3 years, 5%-14.9%) compared with chemotherapy in combination with consolidative thoracic radiotherapy (median: 12.1-18.0 months; 3 years, 15.0%-18.1%). Studies examining whole-brain radiotherapy for brain metastases reported lower median overall survival (5.6-8.7 months) compared with stereotactic radiosurgery (10.0-14.5 months).Conclusions: Under current standard of care, which has remained relatively unchanged over the past few decades, prognosis remains poor for patients with SCLC.

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Section: Resultsmentioning

confidence: 99%

“…1). Twenty-five publications reported outcomes data for limited stage, [17–41] 13 for extensive stage, [42–54] and 2 for both. [55,56] All studies examined OS as the primary outcome.…”

Section: Resultsmentioning

confidence: 99%

Section: Study Characteristics and Quality Assessmentmentioning

confidence: 99%

Section: Outcomes Of Limited-stage Sclcmentioning

confidence: 99%

See 2 more Smart Citations

A systematic literature review of real-world treatment outcomes of small cell lung cancer

et al. 2022

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“…Lung cancer is one of the leading causes of cancer-related mortality and morbidity in China and around the world (1,2). Small-cell lung cancer (SCLC) is the most malignant subtype of lung cancer (3).…”

Section: Introductionmentioning

confidence: 99%

Comprehensive analysis of prognostic predictors for patients with limited-stage small-cell lung cancer who underwent resection followed by adjuvant chemotherapy

et al. 2021

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Background: The prognosis of patients with limited-stage small-cell lung cancer (LS-SCLC) who undergo resection followed by adjuvant chemotherapy (ACT) is uncertain. Thus, we combined clinicopathological characteristics and next-generation sequencing (NGS) to answer this question.Methods: In total, the data of 51 LS-SCLC patients who had undergone complete surgical resection and postoperative ACT were retrospectively collected. NGS examinations with a 68-gene panel were performed for each specimen. Patients' genetic status and potentially clinical correlations were statistically evaluated.Progression-free survival (PFS) and overall survival (OS) were plotted using Kaplan-Meier curves. The independent prognostic factors for the primary cohort were investigated using univariable and multivariable cox proportional hazard regression analyses. Subgroup analyses were also conducted based on retinoblastoma protein 1 (RB1) status.Results: Combined SCLC (c-SCLC) had similar clinical and pathological characteristics to that of pure SCLC (p-SCLC). TP53 and RB1 were 2 major genetic mutations present in both p-SCLC and c-SCLC. c-SCLC had a unique genetic profile that was related to the PI3K/AKT/mTOR and WNT/β-catenin signaling pathways. There was no prognostic difference between c-SCLC and p-SCLC. However, the pathological node (N) stage of lymphovascular invasion (LVI), which was related to PFS and age, corelated with OS. Neither pathological subtypes nor genetic mutations affected the survival outcomes. Notably, RB1 mutated c-SCLC resulted in poorer DFS compared to that of p-SCLC among LS-SCLC patients who underwent resection followed by ACT.Conclusions: Our examination of LS-SCLC patients who underwent resection followed by ACT showed that c-SCLC and p-SCLC had a clinical and prognostic similarity and a genetic peculiarity. Thus, it is essential that a new classification system be proposed for SCLC. Such a system is especially needed for LS-SCLC.

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Comparison of treatment strategies for patients with limited-stage small cell lung cancer who received chemotherapy

Cited by 2 publications

References 22 publications

A systematic literature review of real-world treatment outcomes of small cell lung cancer

A systematic literature review of real-world treatment outcomes of small cell lung cancer

Comprehensive analysis of prognostic predictors for patients with limited-stage small-cell lung cancer who underwent resection followed by adjuvant chemotherapy

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