Predictors of survival and response to treatment in patients with small cell lung cancer (SCLC) are ill-defined and unclear. In an attempt to assess the impact of simple characteristics like presenting symptoms and laboratory values on survival, we undertook this retrospective review of patients with SCLC.
All newly diagnosed SCLC cases from December 2001 through December 2004 were identified and clinical data on presenting symptoms and laboratory findings from their hospital records noted. The influence of various pretreatment factors on survival was investigated using Kaplan-Meier plots and Cox multivariate regression model.
76 subjects were included (84% males, 91% smokers). 57% patients had five or more symptoms at presentation. The median survival duration in patients with limited and extensive disease was 15.3 and 9.8 months respectively. Overall survival was significantly associated with cumulative symptom burden (p=0.02), and strongly with symptomatic response to treatment (p<0.001). Survival was also significantly associated with Karnofsky Performance Status (KPS)(p=0.04) and disease extent (p=0.03). Patients with higher hemoglobin, serum sodium and serum globulin had significantly better survival (p=0.02, 0.04, and 0.02 respectively). By multivariate regression analysis, hemoglobin, KPS and brain metastases were found to be significant predictors of survival (p=0.01, p=0.02, and p<0.01 respectively). Multimodal therapy with both chemotherapy (CT) and radiotherapy (RT) resulted in significantly greater survival benefit than unimodal (either CT or RT), or no therapy (p < 0.001 and p < 0.001 respectively).
Cumulative symptom burden, KPS, disease extent, and symptomatic improvement after treatment are useful predictors of survival in SCLC.
Assessment of symptomatology and other clinical variables may be used as simple tools for risk-stratifying patients into those most likely to achieve survival benefit after therapy. This may also prove more cost-beneficial in developing countries for evaluating response to treatment compared to costly imaging procedures.
Anant Mohan, None.