Prognostic Significance of Pretreatment Laboratory Parameters in Combined Small-Cell Lung Cancer

Abstract

Despite the increasing incidence of combined small-cell lung cancer (C-SCLC) in recent years, there have not been many data on clinical prognostic factors predicting prognosis of C-SCLC patients. In present study, we sought pretreatment features especially basic laboratory parameters predicting survival of C-SCLC. We analyzed 613 small-cell lung cancer (SCLC) patients at our institution between January 2005 and December 2010. We identified 114 patients with C-SCLC. The pathologic and clinical characteristics of these patients were reviewed. Data of laboratory parameters obtained during regular examinations at diagnosis of these patients were examined. The Kaplan-Meier method was used to calculate the survival rate and depict the survival curves. The Cox regression model was used to analyze the independent factors affecting the overall survival (OS). These data were compared with the results obtained from our 499 pure SCLC patients who presented during the same time period. Of the 613 SCLC patients analyzed, 18.6 % of the patients presented with C-SCLC. No difference in OS was observed in patients with C-SCLC and patients with pure SCLC (P = 0.995). The Kaplan-Meier survival curves revealed that poor ECOG-PS (P < 0.001), extensive disease (P < 0.001), pathologic subtype of SC/LC (P < 0.001), not receiving surgery (P = 0.001), elevated serum lactate dehydrogenase (LDH) (P = 0.005), elevated NSE (P = 0.043), and elevated neutrophile-lymphocyte ratio (NLR) (P = 0.018) were associated with adverse prognosis of patients with C-SCLC. By multivariate analysis, OS was affected by ECOG-PS (hazard ratio 2.001, P = 0.012), disease extent (hazard ratio 3.406, P < 0.001), and NLR (hazard ratio 1.704, P = 0.030) in C-SCLC patients, while the risk factors that influenced the prognosis of the patients with pure SCLC were ECOG-PS (hazard ratio 2.132, P < 0.001), disease extent (hazard ratio 1.482, P < 0.001), and LDH (hazard ratio 1.811, P < 0.001). Patients with C-SCLC carry a similar prognosis than those with pure small-cell variety. Easily accessible pretreatment parameters such as NLR should be considered in defining the prognosis of C-SCLC patients besides disease extent and performance status.

High pretreatment neutrophil–lymphocyte ratio predicts recurrence and poor prognosis for combined small cell lung cancer

“…However, the pretreatment PLR was not associated with OS (p = 0.101) or PFS (p = 0.182), which confirmed previous reports [20,24]. Additionally, as the other study reported, our study reconfirmed that extensive disease stage and performance status independently predicted OS (Table 4) [25].…”

Elevated RABEX-5 protein expression predicts poor prognosis in combined small cell lung cancer

“…The incidence of C-SCLC was range from 2 to 45 % has been reported [8,16]. Interestingly, several studies found that if the SCLC patients have undergone surgery, more than 20-40 % had C-SCLC [5,8,17,18]. These studies reminded that, for the non-surgically managed patients, the diagnosis of C-SCLC was limited due to the small-size biopsy tissues.…”

Systemic Immune-inflammation Index, Based on Platelet Counts and Neutrophil-Lymphocyte Ratio, Is Useful for Predicting Prognosis in Small Cell Lung Cancer

“…PNI is not commonly used as a score for the measurement of systemic inflammatory responses, and a study of hepatocellular carcinoma (HCC) found that PNI was an independent and externally validated predictor of poor OS in patients with HCC (Pinato et al 2012). Only two studies have focused on the value of NLR for prognosis in SCLC, with the results indicating that elevated NLR could predict worse OS and PFS (Kang et al 2014;Wang et al 2014). There is, therefore, a lack of data from studies with adequate sample sizes and multiple inflammation-based scores.…”