Analysis Of Chemotherapy-induced Neutropenia And Efficacy In122Small-cell Lung Cancer Cases

Background and Objective： This study assesses whether chemotherapy-inducedneutropenia in SCLC is associated with efficacy，exploring more prognostic factors forSCLC and providing certain theoretical basis for individualized treatment．Methods:1.Through the electronic medical record query system,Collected122patients newlydiagnosed and admitted to oncology department affiliated hospital of DalianMedical University from January1,2008to April1,2013.All the patients received atleast4cycles of chemotherapy with EP or EC regiments.Subjects were stratified by thegrade of neutropenia into three groups:group A(absent,grade0),group B(mild,grade1-2),group C(severe,grade3-4).Subjects were stratified by onset of neutropenia into twogroups:early-onset(lowest neutropenia count of cycles1-2) and non-early-onset (lowestneutropenia count of cycles after2and absence of neutropenia).2.Gathering the patient’s clinical characteristics,including gender,age,stage, ECOG(Eastern Cooperative Oncology Group) score,NSE (neuron specificenolase)levels,chemotherapy regimens,curative effect after4cycles,radiotherapyhistory,whether to accept second-line chemotherapy,survival time,including OS (overallsurvival and overall) and PFS (progression-free survival).3.Analysis were performed using SPSS17.0.A Chi-square test assessed theassociation between the categorical variables and the degree ofneutropenia.Kaplan-Meier plots were used to estimate PFS and OS. The effect of single variables on PFS and OS was assessed using log-rank test and Kaplan-Meier plots.Coxmultivariable regression was used to analyze the prognostic factors of small cell lungcancer.Results:1.Clinical biological characteristics：group A、group B and group C had goodbalances in gender,stage,ECOG score,NSE levels,chemotherapy regimens,curativeeffect after4cycles,radiotherapy history,whether to accept second-line chemotherapy（p＞0.05）,except age．2.Neutropenia and short term efficacy2.1The ORR of group A、B and C are46.7%、30.9%、40.38%,respectively,theirdifference showed no statistic significant(P=0.438>0.05).The ORR of group A、B andC are73.3%、85.5%、86.5%,respectively,their difference showed no statisticsignificant(P=0.439>0.05).But the ORR was higher in group A,DCR was higher ingroup C.2.2The ORR of early-onset group and no-early-onset group are41.5%、31.6%,respectively,their difference showed no statistic significant(P=0.267>0.05).TheDCR of early-onset group and no-early-onset group are89.2%、80.7%,respectively,their difference showed no statistic significant(P=0.325>0.05). Boththe ORR and DCR was higher in early-onset group.3.Neutropenia and long-term survival3.1The OS of group A、 B and C were12.5months、16.0months、14.0months,respectively,their difference showed statistic significant（P=0.044<0.05）.The PFS of group A、B、C were5.5months、7.5months、6.0months,their differenceshowed no statistic significant (P=0.439>0.05).Group B had the longest OS.3.2The OS of early-onset group and non-early-onset group were16.0months、12.5months,respectively,their difference showed statistic significant（P=0.031<0.05）.The early-onset group had the longest OS.The PFS of early-onset group and late-onset group are7.0months、7.0months,respectively,there was no statistic significant（P=0.259>0.05）. 4.Prognosis of small cell lung cancerUnivariate analyses showed,ECOG scor（eP=0.010<0.05）, response to first-linechemotherapy（P=0.014<0.05）, radiotherapy history（P<0.010）,the grade of neutropenia（P=0.044<0.05）,the timing of neutropenia（P=0.031<0.05）were prognostic factorsof small cell lung cancer.Cox multivariable regression showed,ECOGscore,radiotherapy history,the grade of neutropenia were independent prognostic factorsof small cell lung cancer.Conclusion:1.The occurrence of neutropenia during chemotherapy for SCLC is associated withbetter survival,better outcomes are those with mild neutropenia or early-onsetneutropenia.2.ECOG score0-1，recepting radiotherapy，mild neutropenia are better prognosticfactors of small cell lung cancer.