Factors affecting survival and prognosis in extensive stage small cell lung cancer
Abstract Although chemotherapy significantly improves the quality of life and prolongs survival in patients with extensive-stage small cell lung cancer (ES-SCLC), relapse is almost inevitable, with only 5% of patients surviving two years after the initial diagnosis. Prophylactic cranial irradiation...
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BMC
2025-04-01
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| Series: | BMC Pulmonary Medicine |
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| Online Access: | https://doi.org/10.1186/s12890-025-03625-w |
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| author | Mert Erciyestepe Ömer Burak Ekinci Hale Gülçin Yıldırım Doğan Ahmet Emin Öztürk Okan Aydın Aslı Büyükkuşcu Tugay Atasever Beyza Soylu Uslu Kübra Akkaya Emir Çelik Kayhan Ertürk Muhammed Mustafa Atcı |
| author_facet | Mert Erciyestepe Ömer Burak Ekinci Hale Gülçin Yıldırım Doğan Ahmet Emin Öztürk Okan Aydın Aslı Büyükkuşcu Tugay Atasever Beyza Soylu Uslu Kübra Akkaya Emir Çelik Kayhan Ertürk Muhammed Mustafa Atcı |
| author_sort | Mert Erciyestepe |
| collection | DOAJ |
| description | Abstract Although chemotherapy significantly improves the quality of life and prolongs survival in patients with extensive-stage small cell lung cancer (ES-SCLC), relapse is almost inevitable, with only 5% of patients surviving two years after the initial diagnosis. Prophylactic cranial irradiation (PCI) is considered for patients who achieve a complete response, as it has been shown to improve survival rates in this population. Recent studies have also demonstrated that adding PD-L1 inhibitors, such as atezolizumab or durvalumab, to chemotherapy in first-line treatment significantly enhances survival compared to chemotherapy alone. Our study was conducted retrospectively at a single center, including 280 patients with ES-SCLC who began therapy at our institution between July 2009 and February 2023. Patients who underwent thoracic residual radiotherapy (p< 0.001) and PCI (p< 0.001) showed statistically significant improvements in OS. In the first-line treatment group, the median overall survival (OS) for patients receiving cisplatin+etoposide was 12.0 months (10.71 - 13.28), while those treated with carboplatin+etoposide had a median OS of 7.0 months (4.58 - 9.41). For patients receiving carboplatin+etoposide+atezolizumab, the median OS was 35.0 months (21.32 - 48.67), and a statistically significant difference was observed (p< 0.001). In our study, the median OS was 7 months in patients who received ≤ 4 cycles of treatment in the first line and 14 months in patients who received > 4 cycles of treatment. After first-line treatment, the proportion of patients with progression-free survival (PFS) between 0 - 3 months was 21%, and between 3 - 6 months was 24%. PFS was notably worse in those with bone, liver, or brain metastases at diagnosis in the first-line treatment. Multivariate analysis revealed that carboplatin+etoposide+atezolizumab in the first line and cisplatin+etoposide in the second line reduced the risk of both progression and death, while PCI reduced the risk of death. In conclusion, ES-SCLC remains one of the most challenging malignancies, characterized by poor survival rates and short progression-free intervals. Multiple factors influence OS and PFS, some of which are intrinsic to the patient and disease at diagnosis. In contrast, others, such as treatment modalities, the number of treatment cycles, and the application of radiotherapy, can be modified by clinicians. |
| format | Article |
| id | doaj-art-37474d2309f84b9e815ea247d5e85264 |
| institution | OA Journals |
| issn | 1471-2466 |
| language | English |
| publishDate | 2025-04-01 |
| publisher | BMC |
| record_format | Article |
| series | BMC Pulmonary Medicine |
| spelling | doaj-art-37474d2309f84b9e815ea247d5e852642025-08-20T02:11:58ZengBMCBMC Pulmonary Medicine1471-24662025-04-0125111010.1186/s12890-025-03625-wFactors affecting survival and prognosis in extensive stage small cell lung cancerMert Erciyestepe0Ömer Burak Ekinci1Hale Gülçin Yıldırım Doğan2Ahmet Emin Öztürk3Okan Aydın4Aslı Büyükkuşcu5Tugay Atasever6Beyza Soylu Uslu7Kübra Akkaya8Emir Çelik9Kayhan Ertürk10Muhammed Mustafa Atcı11Department of Medical Oncology, Sağlık Bilimleri University, Prof. Dr. Cemil Taşcıoğlu City HospitalDepartment of Medical Oncology, Sağlık Bilimleri University, Prof. Dr. Cemil Taşcıoğlu City HospitalDepartment of Medical Oncology, Sağlık Bilimleri University, Prof. Dr. Cemil Taşcıoğlu City HospitalDepartment of Medical Oncology, Sağlık Bilimleri University, Prof. Dr. Cemil Taşcıoğlu City HospitalDepartment of Medical Oncology, Sağlık Bilimleri University, Prof. Dr. Cemil Taşcıoğlu City HospitalDepartment of Medical Oncology, Sağlık Bilimleri University, Prof. Dr. Cemil Taşcıoğlu City HospitalDepartment of Medical Oncology, Sağlık Bilimleri University, Prof. Dr. Cemil Taşcıoğlu City HospitalDepartment of Medical Oncology, Sağlık Bilimleri University, Prof. Dr. Cemil Taşcıoğlu City HospitalDepartment of Medical Oncology, Sağlık Bilimleri University, Prof. Dr. Cemil Taşcıoğlu City HospitalDepartment of Medical Oncology, Sağlık Bilimleri University, Prof. Dr. Cemil Taşcıoğlu City HospitalDepartment of Medical Oncology, Sağlık Bilimleri University, Prof. Dr. Cemil Taşcıoğlu City HospitalDepartment of Medical Oncology, Sağlık Bilimleri University, Prof. Dr. Cemil Taşcıoğlu City HospitalAbstract Although chemotherapy significantly improves the quality of life and prolongs survival in patients with extensive-stage small cell lung cancer (ES-SCLC), relapse is almost inevitable, with only 5% of patients surviving two years after the initial diagnosis. Prophylactic cranial irradiation (PCI) is considered for patients who achieve a complete response, as it has been shown to improve survival rates in this population. Recent studies have also demonstrated that adding PD-L1 inhibitors, such as atezolizumab or durvalumab, to chemotherapy in first-line treatment significantly enhances survival compared to chemotherapy alone. Our study was conducted retrospectively at a single center, including 280 patients with ES-SCLC who began therapy at our institution between July 2009 and February 2023. Patients who underwent thoracic residual radiotherapy (p< 0.001) and PCI (p< 0.001) showed statistically significant improvements in OS. In the first-line treatment group, the median overall survival (OS) for patients receiving cisplatin+etoposide was 12.0 months (10.71 - 13.28), while those treated with carboplatin+etoposide had a median OS of 7.0 months (4.58 - 9.41). For patients receiving carboplatin+etoposide+atezolizumab, the median OS was 35.0 months (21.32 - 48.67), and a statistically significant difference was observed (p< 0.001). In our study, the median OS was 7 months in patients who received ≤ 4 cycles of treatment in the first line and 14 months in patients who received > 4 cycles of treatment. After first-line treatment, the proportion of patients with progression-free survival (PFS) between 0 - 3 months was 21%, and between 3 - 6 months was 24%. PFS was notably worse in those with bone, liver, or brain metastases at diagnosis in the first-line treatment. Multivariate analysis revealed that carboplatin+etoposide+atezolizumab in the first line and cisplatin+etoposide in the second line reduced the risk of both progression and death, while PCI reduced the risk of death. In conclusion, ES-SCLC remains one of the most challenging malignancies, characterized by poor survival rates and short progression-free intervals. Multiple factors influence OS and PFS, some of which are intrinsic to the patient and disease at diagnosis. In contrast, others, such as treatment modalities, the number of treatment cycles, and the application of radiotherapy, can be modified by clinicians.https://doi.org/10.1186/s12890-025-03625-wExtensive StageSmall Cell Lung CancerSurvival and Prognosis |
| spellingShingle | Mert Erciyestepe Ömer Burak Ekinci Hale Gülçin Yıldırım Doğan Ahmet Emin Öztürk Okan Aydın Aslı Büyükkuşcu Tugay Atasever Beyza Soylu Uslu Kübra Akkaya Emir Çelik Kayhan Ertürk Muhammed Mustafa Atcı Factors affecting survival and prognosis in extensive stage small cell lung cancer BMC Pulmonary Medicine Extensive Stage Small Cell Lung Cancer Survival and Prognosis |
| title | Factors affecting survival and prognosis in extensive stage small cell lung cancer |
| title_full | Factors affecting survival and prognosis in extensive stage small cell lung cancer |
| title_fullStr | Factors affecting survival and prognosis in extensive stage small cell lung cancer |
| title_full_unstemmed | Factors affecting survival and prognosis in extensive stage small cell lung cancer |
| title_short | Factors affecting survival and prognosis in extensive stage small cell lung cancer |
| title_sort | factors affecting survival and prognosis in extensive stage small cell lung cancer |
| topic | Extensive Stage Small Cell Lung Cancer Survival and Prognosis |
| url | https://doi.org/10.1186/s12890-025-03625-w |
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