| Objective: Clinical data,treatment modalities and options of 77 patients diagnosed with SCLC between May 2011 and December 2015 at our department has been reviewed and retrospectively analyzed,we also analysis the disease prognosis, and assess prognostic factors. It aims to understand the status of the actual cases of small cell lung cancer treatment in our department, find out the advantages and disadvantages of the treatment, to provide a reference for future clinical treatment.Method: Review and follow-up by telephone and clinics, medical records, etc. the end of follow-up time was 17 February 2016. Application SPSS21.0 statistical software for data analysis. Univariate analysis was performed using Kaplan-Meire method, the survival curves between groups were compared using Log-rank test, with P <0.05 was considered statistically significant. The study primary endpoint was overall survival(overall survival, OS), and death from the start of treatment to the patient for the first time or the last follow-up time in months. Secondary end points is 1 year, 2-year survival rate.Results: 1. Clinical data and features: Patients’ s onset age mostly above 60 years(71.4%), mainly between 60-75 years of age(61%); predominantly male(81.8%); smoking index more than 400 accounted most(79.2%);Karnofsky score ≥80 were 57 cases(74.0%); lung cancer location of the left lung is 39 cases,right lung is 35 cases,mediastinum is 3 cases; imaging by CT examination showed central type is 49 cases(63.6 %); the patients of extensive-stage is few more than limited-stage, 40 and 37 patients,respectively; TNM stage shows that mainly contains locally advanced stage, III stage patients accounted for 35; I stage only included 2 patients; most patients diagnosed by bronchoscopy(75.3%), followed by percutaneous needle biopsy(9.1%), metastasis biopsies(9.1%), postoperative pathological diagnosis was 3(3.9%) and pleural effusion sediment pathological diagnosis was 2(2.6%); 72(93.5%) patients were pure small cell lung cancer, Combined small cell lung cancer were just 5 cases(6.5%).2.2/5 of patients need second biopsy to confirm CSCLC. And the patients who received average 4 cycles of first-line chemotherapy with EP will lead disease progression. The medium overall survival of patients with extensive stage CSCLC and the same stage of pure SCLC were 9.4months and 13.8 months(P = 0.329).3.Treatment modalities and specific programs: chemotherapy, chest and brain radiation therapy and surgery. 44(57.1%) patients accept chemotherapy alone, followed by 17(22.1%) patients accept chemotherapy and thoracic radiotherapy, 6(7.8%) patients underwent whole brain radiotherapy, 6(7.8%) patients underwent surgical treatment4. Surgical treatment and DFS: only six patients underwent surgical treatment, there was a clear clinical preoperative staging of two cases, and the remaining four cases of stage unclear. The median DFS was 14.3 months, to the date of the follow-up, because only one patient died, unable to calculate the median OS.5. Chemotherapy ± radiotherapy: patients receiving first-line chemotherapy contain 67 patients, including 58 patients receiving EP / EC(86.6%) chemotherapy, 32(47.8%) patients were able to receive six cycles. Chemotherapy of 2 cycles, 4 cycles,and 6 cycles,the ORR were 78.6%, 33.3%, 6.5%, DCR were 91.2%, 80.0% and 61.8%. About half of the patients(50.7%) continues to receview second-line chemotherapy after progression of the first-line chemotherapy. 19 patients(28%) received chest radiation therapy in the chemotherapy group, all patients were not received PCI therapy. The median PFS was 6.9 months,median OS was 15.3 months in the chemoradiotherapy group; 1 year survival rate was 63%, 2-year survival rate was 17%. Univariate analysis showed: Karnofsky score before chemotherapy(P = 0.000), Veterans Administration Lung Study Group staging(P = 0.005), TNM stage(P = 0.014), first-line chemotherapy is full 4 cycles(P = 0.000), numbers of organs metastasis(P = 0.039) are prognostic factors.6.The most common myelosuppression of EP / EC chemotherapy were reduced neutrophil, the incidence of 3 degree and above neutropenia was 62.5% and 56.3%, respectively.7.6 patients continue receiving the original regimen after relapse with an average interval of 6 months of first-line chemotherapy. Including 3 patients undergo two cycles of chemotherapy lead to disease progression,2 patient receive 4 cycles lead progression, and 1 patient receive 4 cycles remains stable. That is to say,after an average of three cycles of chemotherapy will lead to disease progression in 5 patients.The medium OS of the 6 patiens is 17.1 month.8.Changing for a single drug of irinotecan or platinum-based double regimens which differ from the first-line regimens as second-line chemotherapy, median OS was 16.6 months and 10.4 months,respectively, the difference was not statistically significant between the three different sigments of second-line chemotherapy(P = 0.601). The incidence of side effects of monotherapy and doublet chemotherapy was 40% and 88%, respectively; mainly were fatigue, nausea and myelosuppression,respectively.9.Of the 73 patients who receive anti-cancer therapy, the primary organ metastasis is brain, liver, adrenal gland, bone, its metastasis rate was 38.4%, 30.2%, 16.4%, 15.1%, respectively.The incidence of metastasis at the diagose time was 15.1%, 15.1%, 4.1%, 5.5%, respectively. the rare metastasis organ was pancreas and kidney.The median time from the diagnose who did not have brain metastases to the first discovered was 6 months after treatment.Conclusion: 1.Small cell lung cancer occurs in male smokers between the ages of 60-75; CT manifestation shows the mainly is central type;the patients of extensive-stage is little more than the limited-stage at the time of diagnose, limited-stage patients classified by TNM stage shows the locally advanced stage is the main; most patients diagnosed by bronchoscopy.2.Small specimens confirm CSCLC is low accuracy,taking a second biopsy if necessary.Receiving the first-line chemotherapy of EP,The medium overall survival of extensive-stage CSCLC and the same stage of pure SCLC dose not have statistically significant difference.3.For patients with SCLC,the main treatment model is chemotherapy alone,followed by chemotherapy and thoracic radio therapy.Only a few patients undergo surgery.4.The principal first-line chemotherapy regimens is EP/EC. Of Univariate analysis showed: Karnofsky score before chemotherapy, Veterans Administration Lung Study Group staging, TNM stage, full 4 cycles of first-line chemotherapy, numbers of organ metastasis are prognostic factors.5.The incidence of 3 and above degree neutropenia did not have statistical difference of EP/EC.6.Patients who relapse after first-line chemotherapy with an average interval of 6 months, the effect of recieving the original regimen needs further observation. 7.The efficacy and safety of single-agent irinotecan for second-line chemotherapy needs further large sample observation.8.The efficacy of non-first-line platium-based double agents for second-line chemotherapy is poor,and highly toxic.9. The most common organ of distant metastasis is brain, followed by liver, adrenal gland and bone.Brain and liver is the most common metastatic organ at initial diagnosis. |
