Prognostic factors in limited small-cell lung cancer (SCLC): Results of a large retrospective study in a monocentric setting

Abstract

7215 Background: Patients with limited SCLC have a 5-year overall survival of 25% despite aggressive initial treatment. In order to reserve toxic therapeutics to patients who may benefit from it we searched for prognostic factors in large series of localized SCLC treated at a single institution. Methods: Between 1981/10/12 and 2000/11/27, 186 patients with limited SCLC were included in six consecutive prospective trials in our institution. They received polychemotherapy by cisplatin, cyclophosphamide, adriamycin and etoposide with alternated radiotherapy. The median follow-up was 11.26 yrs (reverse Kaplan-Meier). Log-rank test and Cox's proportional-hazards models were used to evaluate the value of prognostic factors and the corresponding hazard ratio (HR) computed. Results: Variables tested in the univariate analysis were : gender (male), age (> 60 yrs), initial Karnofsky (< 90%), Tumor (T3, T4), Node (N2, N3), smoking (>40 PY), initial haemoglobin count (<9.5), initial neutrophils count (<7000/mm3), initial platelets count (>400.000/mm3), haemoglobin toxicity (grade 2 and more), platelets toxicity (grade 2 and more), neutrophils toxicity (grade 3 or more) at the Nadir of the first cycle, initial natremia (≤130 mmol/L) and initial creatininemia (>100 mmol/L). The factors found to be predictive for overall 5-year survival in the univariate analysis (HR) are: Gender (HR=2), Karnofsky (2), Tumor (1.4), initial platelets count (1.8), haemoglobin toxicity (1.6), initial natremia (2), and initial creatinemia (1.9). Among the significant factors in the univariate analysis, two were significant in the multivariate analysis (table). Conclusions: This study confirms the prognostic value of the Karnofsky index and shows the independent prognostic value of the initial platelets count. These factors may define a high risk population to be treated by a different approach. No significant financial relationships to disclose.