OBJECTIVETo evaluate the effect of comprehensive treatment and examine the impact of clinical factors on the survival outcome of limited-stage small cell lung cancer.

METHODSThe clinical records of 335 patients with limited-stage small cell lung cancer treated in the Cancer Hospital of Chinese Academy of Medical Sciences between January 1996 and December 2006 were analyzed retrospectively in this study. Kaplan-Meier method was used for survival analysis, and log-rank test and Cox regression were used for univariate and multivariate analyses of prognostic factors.

RESULTSThe median follow-up time was 54 months for all patients, the median survival time was 23.8 months, and progression-free survival was 12.5 months. The 2-, 3-, and 5-year overall survival rates were 47.3%, 32.9%, and 22.9%, respectively. The acute toxicity during comprehensive treatment was tolerable. The incidence of ≥grade 3 hematological toxicity, ≥grade 3 gastrointestinal toxicity, ≥grade 2 radiation pneumonitis and ≥grade 2 acute esophagitis were 37.0%, 14.9%, 11.0%, and 38.8%, respectively. The univariate analysis showed that KPS<80, smoking and high LDH level significantly reduced the overall survival time in patients with limited-stage SCLC. The multivariate analysis showed that KPS and weight loss were independent factors affecting the prognosis for the limited stage SCLC patients (P<0.05 for all).

CONCLUSIONSSequential chemoradiotherapy can be safely and effectively performed in limited-stage small cell lung cancer. Krnofsky performance status and weight loss are independent prognostic factors for the overall survival of LS-SCLC.

Chemoradiotherapy ; Disease-Free Survival ; Esophagitis ; Humans ; Lung Neoplasms ; diagnosis ; epidemiology ; pathology ; Multivariate Analysis ; Neoplasm Staging ; Prognosis ; Retrospective Studies ; Small Cell Lung Carcinoma ; diagnosis ; epidemiology ; pathology ; Survival Analysis ; Survival Rate

OBJECTIVETo explore the impact of AJCC TNM Staging 7th edition on survival outcome of limited stage small cell lung cancer (SCLC).

METHODSFour hundred and thirty-seven SCLC patients with completed diagnosis and treatment data treated in our department between January 1996 and December 2006 were reclassified according to the AJCC TNM Staging 7th edition. The patients of stages IA, IB, IIA, IIB, IIIA, IIIB were 8, 44, 7, 64, 192 cases, respectively. Kaplan-Meier method was used for survival analysis and log-rank test was used to identify the prognostic factors. The survival rate was determined using chi-square test.

RESULTSThe median follow-up time was 64 months. The median survival time was 26.2 months and median progression free survival time was 13.7 months. The 1-, 2- and 5-year overall survival rates were 86.0%, 52.7%, and 29.7%, respectively. The log-rank test showed that TNM stage is a statistically significant prognostic factor for OS in LS-SCLC (P<0.001). TNM staging system generally allowed a good separation in pairwise comparison for OS between successive stages except there was no significant difference between stages I and II (P=0.061). The 5-year progression free survival rates of patients of stage I, II, IIIA and IIIB were 53.2%, 43.2%, 16.8%, and 10.9%, respectively. TNM stage also was a statistically significant prognostic factor for PFS in LS-SCLC (P<0.001), but there was no significant difference between successive stages (P>0.05 for all). The T staging confirmed significant influence on OS (P<0.001) with no significant difference between successive stages (P>0.05 for all), while T stage was not a significant prognostic factor for PFS in the LS-SCLC patients (P=0.194). N stage also had a significant influence on OS (P<0.001), but with no significant differences between successive stages except N1 and N2 (P=0.001). N staging also showed significant influence on PFS (P=0.001), but with no significant difference between successive stages (P>0.05) except that between the 5-year survival rates of N2 and N3 cases (P=0.013). The cumulative brain metastasis rates of stages I, II, IIIA, and stage IIIB were 17.3%, 28.6%, 33.3%, and 35.8%, respectively(P=0.072), and were 12.8% and 30.8% for pathological stage I and clinical stage I (P=0.203).

CONCLUSIONAJCC TNM Staging 7th edition criteria for LS-SCLC patients have a high prognostic impact and therefore are preferable in clinical practice and future therapeutic trials.

Disease Progression ; Disease-Free Survival ; Humans ; Kaplan-Meier Estimate ; Lung Neoplasms ; mortality ; pathology ; Neoplasm Staging ; methods ; Prognosis ; Retrospective Studies ; Small Cell Lung Carcinoma ; mortality ; pathology ; Survival Analysis ; Survival Rate ; Time Factors

BACKGROUNDThe prognosis of R1-resection at the bronchial stump in patients with non-small cell lung cancer (NSCLC) remains unclear. This study intends to identify the prognostic factors and to optimize treatments for these patients under update conditions.

METHODSThe data of 124 NSCLC patients who underwent R1-resection at the bronchial stump was reviewed. There were 41 patients in the surgery group (S), 21 in the postoperative radiotherapy (PORT) group (S+R), 30 in the postoperative chemotherapy (POCT) group (S+C), and 32 in the PORT plus POCT group (S+R+C). The constitute proportion in different groups was tested using the χ(2) method, univariate analysis was performed using the Kaplan-Meier and log-rank method, and multivariate analysis was done using the Cox hazard regression with entry factors including age, sex, pathological type and stage, classification of the residual disease, and treatment procedure. The process was performed stepwise backward with a maximum iteration of 20 and an entry possibility of 0.05 as well as an excluded possibility of 0.10 at each step.

RESULTSIn univariate analysis, survival was more favorable for patients with squamous cell carcinoma, early pathological T or N stage, and chemotherapy or radiotherapy. There was no significant difference in the survival for patients with different types of the residual disease, except for the difference between patients with carcinoma in situ and lymphangiosis carcinomatosa (P = 0.030). The survival for patients receiving chemoradiotherapy was superior to that for those undergoing surgery alone (P = 0.016). In multivariate analysis, the pathological type (HR 2.51, 95% CI 1.59 to 3.96, P = 0.000), pathological T (HR 1.29, 95% CI 1.04 to 1.60, P = 0.021) or N stage (HR 2.04, 95% CI 1.40 to 2.98, P = 0.000), and chemotherapy (HR 0.24, 95% CI 0.13 to 0.43, P = 0.000) were independent prognostic factors.

CONCLUSIONPatients with squamous cell carcinoma, early pathological T or N stage, or receiving chemotherapy had a more favorable prognosis.

Adult ; Aged ; Aged, 80 and over ; Carcinoma, Non-Small-Cell Lung ; drug therapy ; pathology ; radiotherapy ; surgery ; Female ; Humans ; Lung Neoplasms ; drug therapy ; pathology ; radiotherapy ; surgery ; Male ; Middle Aged ; Prognosis

OBJECTIVETo analyze the efficacy and toxicity of concurrent chemoradiotherapy (CCRT) for patients with locally advanced non-small-cell lung cancer (LA-NSCLC).

METHODSClinical data of 251 patients with stage III (76 IIIA and 175 IIIB) NSCLC who received CCRT as initial treatment between Jan 2001 and Dec 2010 in our hospital were reviewed. A median total radiotherapy dose of 60 Gy (range, 50-74 Gy) were delivered. 174 patients were treated with IMRT, 51 with 3D-CRT and 26 with 2D-radiotherapy. EP chemotherapy regimen was administered in 112 patients, PC regimen in 99 patients, topotecan regimen in 18 patients and other regimens in the remaining 22 patients. The efficacy and toxicity of CCRT were retrospectively analyzed.

RESULTS244 patients were assessable for response, including 6 (2.5%) patients with CR, 183 (75.0%) with PR, 42 (17.2%) with SD and 13 (5.3%) with PD. At a median follow-up period of 20 months, the 1-, 3-, 5- year OS were 69.2%, 31.2%, 23.2%, respectively, and the median OS was 21 months. The 1-, 3-, 5- year PFS were 40.9%, 22.1%, 17.7%, respectively, and the median PFS was 10 months. Patients with stage IIIA NSCLC achieved better 5-year OS than that with IIIB NSCLC (29.2% vs. 20.7%, χ2=2.254, P=0.133). Failure pattern was assessable in 244 patients, including 61 (25.0%) locoregional progression alone, 55 (22.5%) distant metastasis alone and 77 (31.6%) with both. The rates of grade≥3 radiation pneumonitis, esophagitis and hematologic toxicity were 4.4%, 11.2% and 26.4%, respectively.

CONCLUSIONSCCRT provide stage III NSCLC patients favorable outcome with acceptable toxicity. CCRT is standard therapeutic approach for patients with unresectable locally advanced NSCLC.

Antineoplastic Combined Chemotherapy Protocols ; administration & dosage ; therapeutic use ; Carcinoma, Non-Small-Cell Lung ; pathology ; therapy ; Chemoradiotherapy ; Cisplatin ; administration & dosage ; Cyclophosphamide ; administration & dosage ; Esophagitis ; etiology ; Humans ; Lung Neoplasms ; pathology ; therapy ; Neoplasm Staging ; Radiation Pneumonitis ; etiology ; Radiotherapy, Conformal ; Retrospective Studies ; Topotecan ; administration & dosage