| Objective:Most small cell lung cancer(SCLC) patients relapse or progress and have low survival rate although they have significant response to initial chemotherapy and radiotherapy. This study intends to explore the factors affecting the relapse(or progression) of nonoperative SCLC and to show the correlations between progression-free survival(PFS) and overall survival(OS).Methods : Clinical data of 182 patients newly diagnosed with SCLC between 2009 and 2011 at Shanghai CHEST hospital has been reviewed and retrospectively analyzed. All of these investigated patients accepted chemotherapy combined(or not combined) with radiotherapy, and relapsed or progressed after first-line therapy. Univariate Kaplan-Meier survival estimates as well as multivariate Cox regression survival analysis were used to locate the potential factors affecting PFS and OS.PFS and OS of the carboplatin group with the cisplatin group in the two drug group were compared. The differences of the effects of thoracic radiotherapy intervention time and mode of radiotherapy and chemotherapy on PFS and OS were analyzed. The effect of whether or not receiving PCI in the non-brain metastasis group on PFS and OS was also analyzed.The correlation between PFS and OS was analyzed via Bivariate Correlation Analysis method. The Correlation between whether or not receiving PCI and the probability of further brain metastasis was analyzed via Bivariate Correlation Analysis method.Results: 182 patients were enrolled, all of whom received chemotherapy. 78 cases underwent thoracic radiotherapy, and 23 cases received prophylactic cranial irradiation. The Median age was 58.47 years old(range from 30 years old to 79 years old). The Median PFS was 9.57 months(ranged from 1 to 60 months). The Median OS was 17.95 months(ranged from 4 to 84 months). 1-year, 2-year and 3-year survival rates were 60.44%, 29.12% and 17.58% respectively. The univariate estimates showed that the TNM stage(P = 0.000), liver metastasis or not(P = 0.000), brain metastasis or not(P = 0.043), first-line chemotherapy cycles(P = 0.000), effect of initial chemotherapy(P = 0.000), and thoracic radiotherapy combined or not(P =0.000) were the significant contributive factors to PFS. The univariate estimates showed that the hemoglobin level at diagnosis(P=0.005), the TNM stage(P=0.016), liver metastasis or not(P = 0.000), intra-lung metastasis or not(P = 0.016), first-line chemotherapy cycles(P = 0.000), effect of initial chemotherapy(P = 0.010), and thoracic radiotherapy combined or not(P = 0.000) were the significant contributive factors to OS. No statistic difference was observed on PFS and OS of the carboplatin group comparing with the cisplatin group in the two drug group(P>0.05). There was no statistic difference between the effect of thoracic radiotherapy intervention time and mode of radiotherapy and chemotherapy on PFS and OS(P>0.05). In the sub group of the patients without brain metastases, those who received prophylactic cranial irradiation(PCI) had longer PFS and OS(PFS: 17.09 months vs. 8.63 months,P=0.000;OS:30.35 months vs. 16.29 months, P = 0.001). Receiving PCI or not had significant negative correlation with further brain metastases or not(Pearson correlation coefficicient:-0.163,P = 0.032). Cox regression indicated that the three independent variables of first-line chemotherapy cycles(P = 0.002), effect of initial chemotherapy(P =0.000) and thoracic radiotherapy combined or not(P =0.005) were closely related to PFS. The result of Cox regression analysis indicated that OS was remarkably related to the hemoglobin level at diagnosis(P = 0.012), liver metastasis or not(P = 0.027), intra-lung metastasis or not(P = 0.022), first-line chemotherapy cycles(P = 0.027), and thoracic radiotherapy combined or not(P = 0.017). In addition, significant positive correlation between PFS and OS has been observed(Pearson correlation coefficient: 0.655, Pearson, P = 0.000).Conclusion: The median PFS of all small SCLC was 9.57 months; the median OS of all SCLC was 17.95 months. 1-year, 2-year and 3-year survival rates were 60.44%, 29.12% and 17.58% respectively. Significant positive correlation between PFS and OS has been observed(Pearson correlation coefficient: 0.655, Pearson, P = 0.000). PFS could be prolonged by having more first-line chemotherapy cycles(> 4 cycles), obtaining better effect of initial chemotherapy(partial response, PR or complete response, CR), combining with thoracic radiotherapy and implementing PCI for patients without brain metastasis. In the sub group of the patients without brain metastases, PCI or not had significant negative correlation with further brain metastases or not(Pearson correlation coefficicient:-0.163, P = 0.032). |
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