The Prognostic Factors In The Elderly Patients With Small Cell Lung Cancer:A Retrospective Analysis From A Single Cancer Institute

Objectives: We conducted a retrospective study to evaluate the prognostic factors of elderly patients with small cell lung cancer(SCLC).Patients and Methods: The records of elderly patients(? 65 years) with histologically-proven SCLC were reviewed. The patients' information including demographic, clinical and laboratory parameters, staging status on the Veterans Administration Lung Study Group staging system, and treatment modalities were registered. Univariate and multivariate survival analysis was performed by the Kaplan-Meier method and Cox proportional hazards model, respectively.Results: Between January 2004 and December 2012, 247 elderly patients with SCLC were analyzed, 129 patients initially presented with limited stage and 118 with extensive disease. The median age of the patients was 70.7(range 65–83). The median follow-up period for all patients was 22.0 months(range, 1.0–84.0 months) and 39.9 months for surviving patients(range, 4.7–84.0 months). The overall median survival time(MST) was 17.3 months, and the 2-y and 3-y OS rates were 36.3% and 22.7%, respectively. The MST, 2-y and 3-y OS rates were 22 months, 45.0% and 30.5% in patients with limited stage, versus 13.4months, 26.5% and 13.7% in patients having extensive diseases, respectively.The the median PFS, 2-year and 3-year PFS rates were 10.0 months, 23.5% and 18.3% for the whole group, respectively. The median PFS, the 2-year and 3-year PFS rates were 13.0 months, 31.6% and 25.7%, respectively in the LD-SCLC group; and those of the ED-SCLC group were 8.2 months, 13.3% and 7.6%, respectively. Multivariate analysis revealed that disease extent(HR=3.034; p<0.001) and the number of chemotherapy cycles(HR=0.486; p=0.003) were independent prognostic factors for the OS,meanwhile gender was also an important prognostic indicator for PFS(HR, 0.604; P=0.041). In subgroup multivariate analyses according to extent of disease, we discovered chemotherapy cycle and serum NSE as significant prognostic factors for OS(p=0.001 and p=0.017, respectively) and PFS in LD-SCLC group, meanwhile, in ED-SCLC group chemotherapy cycle(HR, 0.529; P=0.016) was identified as independent prognostic indicators for OS and gender(HR, 0.409; p=0.011), chemotherapy cycle(HR, 0.330; p<0.001), pleural effusion(HR, 0.520; p=0.009), radiotherapy(HR, 2.456; p=0.001) were significant independent prognostic indicator for PFS.Conclusion: Disease extent and the number of chemotherapy cycles were independent prognostic factors of elderly patients with SCLC. At the same time, because of individual difference, gender, serum NSE, pleural effusion, radiotherapy mignt have different effects on survival of elderly patients with SCLC.So the fit cohort might benefit from positive treatment.