Multivariate Analysis Of Prognosis Of Stage Ⅰ-Ⅲ Small Cell Lung Cancer

Background:Lung cancer is the most common malignant tumor in China and the world,and the leading cause of cancer death.The incidence rate is increasing year by year.Among them,small cell lung cancer(SCLC)accounts for 15%-20%of lung cancer.SCLC originates from neuroendocrine cells and is a special type of lung cancer with low differentiation,fast growth,high degree of malignancy,and early mediastinal and distant metastasis,although sensitive to radiotherapy and chemotherapy,but with high recurrence rate.SCLC haspoor prognosis as the biological characteristics is different from non-small cell lung cancer(NSCLC).The exact pathogenesis of SCLC is currently unclear,but the prognosis is associated with multiple factors.This study aims to investigate the prognostic factors of patients with stage I-III SCLC through retrospective investigation,which is helpful for clinicians to more comprehensively and accurately assess the patient’s condition,identify high-risk groups,and target their own characteristics,tumor characteristics,and develop a personalized treatment plan that is tailored to the human condition,thereby prolonging the life of the patient and improving the quality of life of the patient.Methods:According to the exclusion criteria,patients with stage I-III SCLC who were first seen in the China-Japan Friendship Hospital from January 2008 to January 2018 were selected as subjects.The clinicopathological features and treatment data were collected and followed up by telephone or email.Patients were followed up to obtain survival data.SAS 9.4 and SPSS 25.0 software were used to analyze the relevant clinicopathological factors and survival time.The median survival time,median progression-free time,and 1-,3-,and 5-year survival rates were calculated.The Kaplan-Meier method was used to map survival.The Log-Rank testwas used tounivariate analysis.Cox risk regression modelwas used to analyse multivariate prognostic analyse.P<0.05 was considered statistically significant.Results:A total of 82 patients with stage I-III SCLC were enrolled in the study.The median overall survival time(mOS)was 33 months,and the median progression-free survival time(mPFS)was 20 months.The annual survival rate ofl year,3 years,5 yearswere 95%,45%,and 32%.Univariate analysis showed that tumor size(T,P=0.025),lymph node metastasis(N,P<0.001),TNM stage(P=0.002),lymphocyte count(L,P<0.001),prognostic nutritional index(PNI,P=0.043),neuron-specific enolase(NSE,P=0.016),surgery(P=0.001),traditional Chinese medicine(P=0.002)were associated with OS;lymph node metastasis(P=0.041),lymphocytes Count(L,P=0.001),lung cancer inflammation index(ALI,P<0.001),surgery(P=0.018),Chinese medicine(P=0.032)were related to PFS.While,was There were no significant difference in survival with age,gender,smoking history,family history,KPS score,paraneoplastic syndrome,pathological type,other inflammatory indicators(neutrophil count,platelet count,neutrophil/lymphocyte ratio,platelet/lymphocyte ratio),serum albumin,lactate dehydrogenase,carcinoembryonic antigen(P>0.05).Multivariate analysis showed that N2-3(N2:P=0.028,N3:P=0.010),lymphocyte count(P=0.040)wereindependent factorsaffecting OS of stage Ⅰ-Ⅲ SCLC patients;lung cancer inflammation index(P=0.003)was independent factors affecting PFS in patients with stage Ⅰ-Ⅲ SCLC;whether surgery(OS,PFS were P<0.001)and tradition Chinese medicine treatment(OS:P<0.001,PFS:P=0.006)were independent factors affecting OS and PFS.Conclusions:The median survival time,median progression-free survival time,and survival rate of all patients were longer than previous studies,which may be related to the synergy of various factors such as clinical stage,inflammatory state,nutritional status,surgical treatment and TCM treatment.The limited heterogeneity of small cell lung cancer(LS-SCLC)is based on the same American Association of Cancer(AJCC)8th edition TNM staging as non-small cell lung cancer(NSCLC),which can effectively distinguish the prognosis of patients with LS-SCLC.The inflammatory state and nutritional status of the patient are related to the prognosis of the patient,that is,the inflammatory state is negatively correlated with the prognosis of the patient,and the nutritional status is positively correlated with the prognosis of the patient.Chemotherapy-based combination therapy is the primary treatment modality for patients with stage Ⅰ-Ⅲ SCLC.For patients who can undergo surgery,surgical treatment can prolong the patient’s survival.Traditional Chinese medicine has anti-tumor effect.Compared with chemotherapy alone,traditional Chinese medicine can delay tumor recurrence,prolong the overall survival of patients and improve long-term survival rate.Although the survival difference in terms of age,gender,smoking history,family history,KPS score,paraneoplastic syndrome,pathological type,lactate dehydrogenase(LDH)werenot statistically significant(P>0.05).