Prospective evaluation of patients with small cell lung cancer: A single center study

Abstract

Aim: Small cell lung cancer (SCLC) is the most aggressive form of lung cancer. No major treatment advances have occurred for SCLC over the past 30 years, unlike non-small cell lung cancer (NSCLC). We aimed to prospectively examine demographic, clinical, radiological properties, its association with cigarette smoking, delays in diagnosis, treatment responses, toxicities, prognostic factors, and survivals. Methods: Patients diagnosed with small cell lung cancer during 4 years in Ondokuz Mayıs University, Department of Chest Diseases were included in our prospective cohort study. The demographic characteristics of the patients, symptoms, performance status, laboratory, radiologic, bronchoscopy findings, staging procedures, periods from the initiation of the symptoms to the admission of the patients to our department and definitive diagnosis, chemotherapy responses and toxicities were recorded. Follow-ups were performed in our clinic. Dates of deaths of patients who died outside our hospital were followed up from the records of census directorate. Patients that we lost to follow up, with missing data, or those who did not give consent for participation in the study were excluded. Results: The study group consisted of 88 patients (82 males, 6 females). The mean age was 61.16 years. The main symptoms on admission were cough (77%), fatigue (62%), dyspnea (60%). Among all, 39% of patients had limited disease whereas the remaining 61% were extensive. The median delay between the occurrence of first symptom and the patient’s presentation to our clinic was 30 days and the median delay before diagnosis was 10 days. Seventy-seven patients were given cisplatin/carboplatin-etoposide as the first line and irinotecan as second line chemotherapy. Overall median survival was 355 (30.8) days, 416 (47) days in limited stage and 296 (48) days in the extensive stage (P=0.003). Six-month cumulative survival was 76%, and 12-month cumulative survival was 44%. Univariate analysis showed that increased LDH levels, performance score >1, extensive stage and weight loss were poor prognostic factors (P=0.042, 0.001, 0.003, 0.022). In multivariate analysis, serum LDH levels, performance score >1 and extensive disease were independent poor prognostic factors. Conclusion: The ratio of our female patients is still much lower than the world average. Time from the admission of our patients to diagnosis was shorter than most of the developed countries. However, treatment response rates and survival periods were within lower limits of world reports. Stage, PS, LDH can be used as independent prognostic factors.