Tuberculosis and Respiratory Diseases

The Korean Academy of Tuberculosis and Respiratory Diseases (대한결핵및호흡기학회)
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Progression-Free Survival: An Important Prognostic Marker for Long-Term Survival of Small Cell Lung Cancer

  • Park, Myoung-Rin (Department of Public Health Administration, The Province of Chungcheongnam-do) ;
  • Park, Yeon-Hee (Department of Internal Medicine, Chungnam National University Hospital, Chungnam National University School of Medicine) ;
  • Choi, Jae-Woo (Department of Internal Medicine, Chungnam National University Hospital, Chungnam National University School of Medicine) ;
  • Park, Dong-Il (Department of Internal Medicine, Chungnam National University Hospital, Chungnam National University School of Medicine) ;
  • Chung, Chae-Uk (Department of Internal Medicine, Chungnam National University Hospital, Chungnam National University School of Medicine) ;
  • Moon, Jae-Young (Department of Internal Medicine, Chungnam National University Hospital, Chungnam National University School of Medicine) ;
  • Park, Hee-Sun (Department of Internal Medicine, Chungnam National University Hospital, Chungnam National University School of Medicine) ;
  • Jung, Sung-Soo (Department of Internal Medicine, Chungnam National University Hospital, Chungnam National University School of Medicine) ;
  • Kim, Ju-Ock (Department of Internal Medicine, Chungnam National University Hospital, Chungnam National University School of Medicine) ;
  • Kim, Sun-Young (Department of Internal Medicine, Chungnam National University Hospital, Chungnam National University School of Medicine) ;
  • Lee, Jeong-Eun (Department of Internal Medicine, Chungnam National University Hospital, Chungnam National University School of Medicine)
  • Received : 2014.01.24
  • Accepted : 2014.03.14
  • Published : 2014.05.30
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Abstract

Background: Small cell lung cancer (SCLC) is an extremely aggressive tumor with a poor clinical course. Although many efforts have been made to improve patients' survival rates, patients who survive longer than 2 years after chemotherapy are still very rare. We examined the baseline characteristics of patients with long-term survival rates in order to identify the prognostic factors for overall survivals. Methods: A total of 242 patients with cytologically or histologically diagnosed SCLC were enrolled into this study. The patients were categorized into long- and short-term survival groups by using a survival cut-off of 2 years after diagnosis. Cox's analyses were performed to identify the independent factors. Results: The mean patient age was 65.66 years, and 85.5% were males; among the patients, 61 of them (25.2%) survived longer than 2 years. In the multivariate analyses, CRP (hazard ratio [HR], 2.75; 95% confidence interval [CI], 1.25-6.06; p=0.012), TNM staging (HR, 3.29; 95% CI, 1.59-6.80; p=0.001), and progression-free survival (PFS) (HR, 11.14; 95% CI, 2.98-41.73; p<0.001) were independent prognostic markers for poor survival rates. Conclusion: In addition to other well-known prognostic factors, this study discovered relationships between the long-term survival rates and serum CRP levels, TNM staging, and PFS. In situations with unfavorable conditions, the PFS would be particularly helpful for managing SCLC patients.

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References

  1. Chua YJ, Steer C, Yip D. Recent advances in management of small-cell lung cancer. Cancer Treat Rev 2004;30:521-43. https://doi.org/10.1016/j.ctrv.2004.06.003
  2. Usuda K, Saito Y, Sagawa M, Sato M, Kanma K, Takahashi S, et al. Tumor doubling time and prognostic assessment of patients with primary lung cancer. Cancer 1994;74:2239-44. https://doi.org/10.1002/1097-0142(19941015)74:8<2239::AID-CNCR2820740806>3.0.CO;2-P
  3. Tanaka K, Shimada H, Miura M, Fujii Y, Yamaguchi S, Endo I, et al. Metastatic tumor doubling time: most important prehepatectomy predictor of survival and nonrecurrence of hepatic colorectal cancer metastasis. World J Surg 2004;28:263-70. https://doi.org/10.1007/s00268-003-7088-3
  4. Kerr KM, Lamb D. Actual growth rate and tumour cell proliferation in human pulmonary neoplasms. Br J Cancer 1984;50:343-9. https://doi.org/10.1038/bjc.1984.181
  5. Ost D, Fein AM, Feinsilver SH. Clinical practice. The solitary pulmonary nodule. N Engl J Med 2003;348:2535-42. https://doi.org/10.1056/NEJMcp012290
  6. Souhami RL, Law K. Longevity in small cell lung cancer. A report to the Lung Cancer Subcommittee of the United Kingdom Coordinating Committee for Cancer Research. Br J Cancer 1990;61:584-9. https://doi.org/10.1038/bjc.1990.131
  7. Paesmans M, Sculier JP, Lecomte J, Thiriaux J, Libert P, Sergysels R, et al. Prognostic factors for patients with small cell lung carcinoma: analysis of a series of 763 patients included in 4 consecutive prospective trials with a minimum follow-up of 5 years. Cancer 2000;89:523-33. https://doi.org/10.1002/1097-0142(20000801)89:3<523::AID-CNCR7>3.0.CO;2-6
  8. Ando S, Suzuki M, Yamamoto N, Iida T, Kimura H. The prognostic value of both neuron-specific enolase (NSE) and Cyfra21-1 in small cell lung cancer. Anticancer Res 2004;24:1941-6.
  9. Ou SH, Ziogas A, Zell JA. Prognostic factors for survival in extensive stage small cell lung cancer (ED-SCLC): the importance of smoking history, socioeconomic and marital statuses, and ethnicity. J Thorac Oncol 2009;4:37-43. https://doi.org/10.1097/JTO.0b013e31819140fb
  10. Singh S, Parulekar W, Murray N, Feld R, Evans WK, Tu D, et al. Influence of sex on toxicity and treatment outcome in smallcell lung cancer. J Clin Oncol 2005;23:850-6. https://doi.org/10.1200/JCO.2005.03.171
  11. Micke P, Faldum A, Metz T, Beeh KM, Bittinger F, Hengstler JG, et al. Staging small cell lung cancer: Veterans Administration Lung Study Group versus International Association for the Study of Lung Cancer--what limits limited disease? Lung Cancer 2002;37:271-6. https://doi.org/10.1016/S0169-5002(02)00072-7
  12. National Comprehensive Cancer Network. The NCCN clinical practice guidelines in oncology: small cell lung cancer (version V.II.2014) [Internet]. Fort Washington: National Comprehensive Cancer Network; 2013 [cited 2013 Oct 3]. Available from: http://www.nccn.org/professionals/physician_gls/pdf/sclc.pdf.
  13. Wang CS, Sun CF. C-reactive protein and malignancy: clinicopathological association and therapeutic implication. Chang Gung Med J 2009;32:471-82.
  14. McMillan DC, Canna K, McArdle CS. Systemic inflammatory response predicts survival following curative resection of colorectal cancer. Br J Surg 2003;90:215-9. https://doi.org/10.1002/bjs.4038
  15. Nozoe T, Saeki H, Sugimachi K. Significance of preoperative elevation of serum C-reactive protein as an indicator of prognosis in esophageal carcinoma. Am J Surg 2001;182:197-201. https://doi.org/10.1016/S0002-9610(01)00684-5
  16. Nagaoka S, Yoshida T, Akiyoshi J, Akiba J, Torimura T, Adachi H, et al. Serum C-reactive protein levels predict survival in hepatocellular carcinoma. Liver Int 2007;27:1091-7. https://doi.org/10.1111/j.1478-3231.2007.01550.x
  17. Hara M, Matsuzaki Y, Shimuzu T, Tomita M, Ayabe T, Enomoto Y, et al. Preoperative serum C-reactive protein level in non-small cell lung cancer. Anticancer Res 2007;27:3001-4.
  18. Scott HR, McMillan DC, Forrest LM, Brown DJ, McArdle CS, Milroy R. The systemic inflammatory response, weight loss, performance status and survival in patients with inoperable non-small cell lung cancer. Br J Cancer 2002;87:264-7. https://doi.org/10.1038/sj.bjc.6600466
  19. Milroy R, Shapiro D, Shenkin A, Banham SW. Acute phase reaction during chemotherapy in small cell lung cancer. Br J Cancer 1989;59:933-5. https://doi.org/10.1038/bjc.1989.197
  20. Arpin D, Trillet-Lenoir V, Lasset C, Souquet PJ, Riou R, Yoanidis I, et al. [Value of C-reactive protein determination in small cell lung cancer]. Bull Cancer 1993;80:1063-8.
  21. Hong S, Kang YA, Cho BC, Kim DJ. Elevated serum C-reactive protein as a prognostic marker in small cell lung cancer. Yonsei Med J 2012;53:111-7. https://doi.org/10.3349/ymj.2012.53.1.111
  22. Zelen M. Keynote address on biostatistics and data retrieval. Cancer Chemother Rep 3 1973;4:31-42.
  23. Shepherd FA, Crowley J, Van Houtte P, Postmus PE, Carney D, Chansky K, et al. The International Association for the Study of Lung Cancer lung cancer staging project: proposals regarding the clinical staging of small cell lung cancer in the forthcoming (seventh) edition of the tumor, node, metastasis classification for lung cancer. J Thorac Oncol 2007;2:1067-77. https://doi.org/10.1097/JTO.0b013e31815bdc0d
  24. Guidance for industry: clinical trial endpoints for the approval of cancer drugs and biologics [Internet]. Rockville: U.S. Department of Health and Human Services, Food and Drug Administration, Center for Drug Evaluation and Research, Center for Biologics evaluation and Research; 2007 [cited 2013 Oct 2]. Available from: http://www.fda.gov/downloads/ Drugs/GuidanceComplianceRegulatoryInformation/Guidances/ucm071590.pdf.
  25. Bergmann L, Hirschfeld S, Morris C, Palmeri S, Stone A. Progression-free survival as an end-point in clinical trials of biotherapeutic agents. Eur J Cancer Suppl 2007;5:23-8.
  26. Dancey JE, Dodd LE, Ford R, Kaplan R, Mooney M, Rubinstein L, et al. Recommendations for the assessment of progression in randomised cancer treatment trials. Eur J Cancer 2009;45:281-9. https://doi.org/10.1016/j.ejca.2008.10.042
  27. Buyse M, Burzykowski T, Carroll K, Michiels S, Sargent DJ, Miller LL, et al. Progression-free survival is a surrogate for survival in advanced colorectal cancer. J Clin Oncol 2007;25:5218-24. https://doi.org/10.1200/JCO.2007.11.8836
  28. Lamborn KR, Yung WK, Chang SM, Wen PY, Cloughesy TF, DeAngelis LM, et al. Progression-free survival: an important end point in evaluating therapy for recurrent high-grade gliomas. Neuro Oncol 2008;10:162-70. https://doi.org/10.1215/15228517-2007-062
  29. Amir E, Seruga B, Kwong R, Tannock IF, Ocana A. Poor correlation between progression-free and overall survival in modern clinical trials: are composite endpoints the answer? Eur J Cancer 2012;48:385-8. https://doi.org/10.1016/j.ejca.2011.10.028
  30. Jackman DM, Johnson BE. Small-cell lung cancer. Lancet 2005;366:1385-96. https://doi.org/10.1016/S0140-6736(05)67569-1
  31. Johnson BE, Makuch RW, Simmons AD, Gazdar AF, Burch D, Cashell AW. myc family DNA amplification in small cell lung cancer patients' tumors and corresponding cell lines. Cancer Res 1988;48:5163-6.
  32. Brennan J, O'Connor T, Makuch RW, Simmons AM, Russell E, Linnoila RI, et al. myc family DNA amplification in 107 tumors and tumor cell lines from patients with small cell lung cancer treated with different combination chemotherapy regimens. Cancer Res 1991;51:1708-12.
  33. Friberg S, Mattson S. On the growth rates of human malignant tumors: implications for medical decision making. J Surg Oncol 1997;65:284-97. https://doi.org/10.1002/(SICI)1096-9098(199708)65:4<284::AID-JSO11>3.0.CO;2-2

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