Survival In Small Cell Carcinoma Research Articles

<p>Clinicopathological Characteristics and Survival of Small Cell Carcinoma of the Salivary Gland: a Population-Based Study</p>

BackgroundSmall cell carcinoma (SmCC) of the salivary gland is rare, and the characteristics and survival are not well defined due to only case reports or case series being reported. The present study aimed to describe the clinicopathological characteristics and determine the factors associated with survival of this rare cancer.Materials and methodsA population-based study was carried out to investigate clinical characteristics and prognosis of SmCC of the salivary gland using prospectively extracted data from the Surveillance, Epidemiology and End Results (SEER) database between 1988 and 2016.ResultsTotally, 198 patients with SmCC of the salivary gland were identified with an average age of 72.6±12.4 and a male to female ratio of 3.4:1. The lesions of most patients (167/198) were located in the parotid gland. The median overall survival (mOS) of all patients is 25.0 months. The 1-, 3-, 5- and 10-year survival rate was 65.7%, 40.9%, 33.0% and 22.7%, respectively. Surgery could prolong significantly the mOS by almost 17.0 months (28.0 months vs 11.0 months; P<0.01). Radiotherapy, as well as radiotherapy after surgery, could prolong the mOS (P<0.01 for both). Patients who received chemotherapy had significantly longer overall survival time than those without chemotherapy (28.0 months vs 20 months; P=0.04). The survival analysis demonstrated that old age (>72 years), lymph node (N3) and distant metastases were independent factors for poor survival, whereas radiotherapy was an independent factor for favorable survival.ConclusionSmall cell carcinoma of the salivary gland is a rare disease, and old age, lymph node and distant metastases, and radiotherapy were significantly associated with prognosis. In order to understand this disease more thoroughly, more cases with adequate information are required.

Clinicopathological features of small cell carcinoma of the uterine cervix in the surveillance, epidemiology, and end results database.

To investigate the clinicopathological characteristics and survival of small cell carcinoma of the cervix using Surveillance, Epidemiology, and End Results database. Patients with a diagnosis of small cell carcinoma of the cervix were included between 1988 and 2012. Kaplan-Meier method and Cox regression models were used. A total of 487 patients were included. Of the patients with known International Federation of Gynecology and Obstetrics stage and tumor grade, the stage IV disease was diagnosed in 37.9% patients, and 98.5% patients had poorly or undifferentiated histology. The 5-year cause specific survival and overall survival were 33.0% and 29.4%, respectively. In multivariate analysis, increasing age, advanced stage, and treatment by primary radiotherapy were associated with worse survival outcomes. Small cell carcinoma of the cervix is a rare disease with aggressive characteristics and prone to metastasize and is dismal in prognosis. Reduced survival was associated with increasing age, advanced stage, and treatment by primary radiotherapy.

Treatment with Radiation and Chemotherapy Improve Survival in Small Cell Carcinoma of Rectum

Treatment with Radiation and Chemotherapy Improve Survival in Small Cell Carcinoma of Rectum

Epidemiology and survival of small cell carcinoma of gastrointestional tract: A Surveillance, Epidemiology, and End Results (SEER) database review.

518 Background: Small cell carcinoma of the gastrointestinal tract is an uncommon histology. Limited literature is available to clinicians about the incidence, distribution and prognosis of small cell carcinoma of the gastrointestinal tract (SCGIT). We reviewed the Survival, Epidemiology and End Result (SEER) database of National Cancer Institute to understand its epidemiology and prognosis. Methods: SEER database was reviewed for patients with histologically confirmed SCGIT (8041-45) and its variants in the GIT between 2002-2007 (all stages). Variables included were age, gender, race, primary site and disease specific survival. The incidence pattern across race, gender, and site of origin for SCGIT was investigated. Chi square test was used to assess the difference of incidence pattern. 5-yr survival rate across various sites was estimated using the Kaplan–Meier method and the difference in 5-yr survival was tested by log-rank test. If the significant difference is detected, the paired comparison was performed and the p-values were adjusted by Tukey multiple-comparison method. Results: A total of 645 patients were included. The distribution of SCGIT was: colorectal (30.08%), esophagus (22.17%), pancreas (20.16%), hepatobiliary (11.63%), stomach (9.61%) and NOS (6.63%). The incidence pattern of SCGIT in males and female was significantly different (p &lt; 0.0008). Males had a higher incidence of esophagus; stomach and pancreas while females had a higher incidence of hepatobiliary, colorectal and NOS sites. Five-year survival of SCGIT was significantly associated with the primary site of disease (p = 0.03). Paired-comparison results showed that the 5-yr survival rate for patients with pancreas small cell cancer was significantly lower than patients with stomach or NOS(4.80% -pancreas vs 5.22 %-stomach and 12.81% - NOS) (p = 0.04 and p = 0.003 respectively). There was not a significant difference between other sites. Conclusions: Small cell carcinoma of the GI tract has difference in incidence patterns between genders. The 5-yr survival of patients with pancreatic small cell carcinoma is significantly lower as compared to stomach or NOS.

A population-based study of incidence and patient survival of small cell carcinoma in the United States, 1992-2010.

BackgroundIn contrast to the well-described epidemiology and behavior of small cell lung carcinoma (SCLC), little is known about extrapulmonary small cell carcinoma (EPSCC).MethodsUsing data from the Surveillance, Epidemiology and End Results (SEER) Program (1992–2010), we calculated age-adjusted incidence rates (IRs), IR ratios (IRRs), annual percent change (APC), relative survival (RS), RS ratios (RSRs), and the respective 95% confidence intervals (95% CI) of SCLC and EPSCC according to primary site. We used the SEER historic stage variable that includes localized (confined to the organ of origin), regional (direct extension to adjacent organ/tissue or regional lymph nodes), and distant (discontinuous metastases) stages and combined localized and regional stages into “limited” stage.ResultsThe incidence of SCLC (IR = 76.3/million person-years; n = 51,959) was 22-times that of EPSCC (IR = 3.5; n = 2,438). Of the EPSCC sites, urinary bladder, prostate, and uterine cervix had the highest incidence (IRs = 0.7-0.8); urinary bladder (IRR = 4.91) and stomach (IRR = 3.46) had the greatest male/female disparities. Distant-to-limited stage site-specific IRRs of EPSCC were significantly elevated for pancreas (IRR = 6.87; P < 0.05), stomach, colon/rectum, ovary, and prostate (IRRs = 1.62-2.42; P < 0.05) and significantly decreased for salivary glands, female breast, uterine cervix, and urinary bladder (IRRs = 0.32-0.46). During 1992–2010, significant changes in IRs were observed for EPSCC overall (APC = 1.58), small cell carcinoma of the urinary bladder (APC = 6.75), SCLC (APC = −2.74) and small cell carcinoma of unknown primary site (APC = −4.34). Three-year RS was significantly more favorable for patients with EPSCC than SCLC for both limited (RSR = 2.06; 95% CI 1.88, 2.26) and distant stages (RSR = 1.55; 95% CI 1.16, 2.07). Among limited stage small cell carcinoma, RS was most favorable for salivary glands, female breast, and uterine cervix (RS = 52-68%), whereas RS for nearly all sites with distant stage disease was <10%.ConclusionEPSCC comprises a heterogeneous group of diseases that appears, at least in part, etiologically distinct from SCLC and is associated with more favorable stage-specific patient survival.Electronic supplementary materialThe online version of this article (doi:10.1186/s12885-015-1188-y) contains supplementary material, which is available to authorized users.

Effect of autoimmune diseases on risk and survival in histology-specific lung cancer

Patients with autoimmune diseases are at an increased risk of cancer due to underlying dysregulation of the immune system or treatment. Data on cancer incidence, mortality and survival after autoimmune diseases would provide further information on the clinical implications. We systematically analysed data on lung cancer in patients diagnosed with 33 different autoimmune diseases. Standardised incidence ratios (SIRs), standardised mortality ratios (SMRs) and hazard ratios (HRs) were calculated for subsequent incident lung cancers or lung cancer deaths up to 2008 in patients hospitalised for autoimmune disease after 1964. Increased risks of lung cancer were recorded for SIRs after 12 autoimmune diseases, SMRs after 11 autoimmune diseases and HRs after two autoimmune diseases. The highest SIRs and SMRs, respectively, were seen after discoid lupus erythematosus (4.71 and 4.80), polymyosistis/dermatomyositis (4.20 and 4.17), systemic lupus erythematosus (2.47 and 2.69), rheumatic fever (2.07 and 2.07) and systemic sclerosis (2.19 and 1.98). Autoimmune disease did not influence survival overall but some autoimmune diseases appeared to impair survival in small cell carcinoma. All autoimmune diseases that had an SIR >2.0 are known to present with lung manifestations, suggesting that the autoimmune process contributes to lung cancer susceptibility. The data on survival are reassuring that autoimmune diseases do not influence prognosis in lung cancer.

The effect of anticoagulant drugs on cancer

The effect of anticoagulant drugs on cancer

Prospective population-based study on the survival of patients with lung cancer.

The purpose of this study was to evaluate the change, over 20 yrs, in the survival of lung cancer patients in a population-based study. Information on all patients with lung cancer in a defined geographical area during 1990-1992 (n=602) was prospectively gathered. The survival of these patients was assessed and also compared with the results of a similar study in the same area during the years 1968-1971 (n=446). The 5-yr survival had improved during 20 yrs from 4% to 12%. The 5-yr survival of the patients with squamous cell carcinoma had increased from 6% to 16%, and adenocarcinoma from 4% to 19%, whereas the survival of small cell carcinoma had remained the same (2% and 3%, respectively). Even though the recent patients were older than those of the earlier series the proportion of surgically treated patients had remained the same (16% and 20%), but the 5-yr survival of patients who had been operated on had increased significantly from 23% to 48%. The differences in survival in the second cohort (1990-1992) between histological types (Chi-squared logrank=59.2), tumour, node, metastasis stages (Chi-squared logrank=199.6), symptomatic stages (Chi-squared logrank=120, p<0.001) and treatment (Chi-squared logrank=277) were significant. Based on this study the independent prognostic factors for better survival of lung cancer patients are tumour, node, metastasis stages I and II, surgical treatment and Feinstein's symptomatic stages I and II.

Does the substitution of cisplatin in a standard four drug regimen improve survival in small cell carcinoma of the lung? A comparison of two chemotherapy regimens.

Ninety five patients with small cell carcinoma of the lung were randomly assigned to one of two chemotherapy regimens (VACE or CVACE), each consisting of six cycles at three week intervals. The VACE regimen consisted of six cycles of vincristine 1.2 mg/m2, doxorubicin 40 mg/m2, and cyclophosphamide 700 mg/m2 on day 1 plus etoposide 110 mg/m2 daily for three days. The CVACE regimen was identical to the VACE regimen for cycles 3 and 4; cycles 1, 2, 4, and 6 consisted of etoposide 110 mg/m2 for three days plus cisplatin 100 mg/m2 with mannitol diuresis on the second day. Forty eight patients received VACE and 47 CVACE. Side effects resulted in withdrawal of four patients receiving VACE and six receiving CVACE. Three deaths were attributed to VACE and one to CVACE. Median survival did not differ between the two treatments overall, though there was a small increase in median survival in partial responders receiving CVACE. It is concluded that replacing four of the six cycles of VACE (vincristine, doxorubicin, cyclophosphamide, and etoposide) with etoposide and cisplatin conferred no overall advantage.

Long-term survival in small cell carcinoma of the lung

A series of 1019 patients with small cell carcinoma of the lung, treated at the Department of Radiotherapy and Oncology at the Helsinki University Central Hospital during the period 1963–1982, included 19 patients who survived for 5 years or more after the diagnosis. The clinical data of these patients were retrospectively studied in order to elucidate factors which may have contributed to the more favourable outcome. All of the 5-year survivors were previously untreated, and all had a good performance status at the time of diagnosis. In 95%, the disease was limited to one hemithorax, and 74% had a stage I or II tumour. All treatment modalities, except immunotherapy, were used during the two decades. Surgery alone, or with adjuvant radiotherapy, and/or chemotherapy, was the primary treatment in eight of the long-term survivors ( 42%). Chemotherapy, either alone or in combination with radiotherapy, was the primary treatment in 10 19 ( 53%) patients and radiotherapy alone was given to one of the 5-year survivors. The objective response rate to the primary treatment was 100% and complete response was achieved in 95%. There were seven carcinoma related deaths after 5-year disease-free survival. The first site of relapse was the central nervous system in three cases and the liver in three cases. Acute myocardial infarction was the cause of death in five patients. One patient died of the other carcinoma and six are still alive with no evidence of SCCL. In conclusion, a good performance status at diagnosis, no pretreatment weight loss, the extent of disease and good response to the primary treatment appeared to be prognostically important in the present study. Some patients with very limited disease may benefit from primary treatment comprising surgery and adjuvant chemotherapy.

Long-term survival in small cell carcinoma of the lung

We analyzed the long-term survivors in a group of 255 patients with newly diagnosed small cell carcinoma of the lung (SCCL) between January 1978 and July 1983. Long-term survivors were defined as those patients free of cancer 2 years after initiation of therapy. Only 6 patients ( 2.5%) were free of disease at this time. Two patients relapsed at 29 and 40 months from the start of chemotherapy. Both patients were retreated with chemotherapy, and one of them achieved a complete response. Despite the increase in median survival in SCCL with chemotherapy over the past 10 years, long-term prognosis remains very poor employing standard treatments.

Prognostic influence of TNM staging and LDH levels in small cell carcinoma of the lung (SCCL).

To better define the prognostic factors influencing the response to therapy and survival in small cell carcinoma of the lung (SCCL), an expanded "TNM" type staging system was developed and investigated in a series of 73 protocol treated patients. Because serum LDH levels at disease presentation have been correlated to disease extent, response to therapy, and treatment outcome in a number of malignancies, including SCCL, these interrelationships were also analyzed in the protocol patients. The TNM system was found to be a more descriptive and specific "shorthand" for denoting sites of involvement and for indicating the body burden of tumor than the traditional limited-extensive disease (LD-ED) system. A clear statistical advantage could not be shown over the LD-ED system for predicting chemotherapy response or survival, although there were trends suggesting the TNM system could divide patients into three prognostic subgroups. Serum LDH proved to be a useful index of disease extent and therapy outcome. LDH levels at presentation were proportionately higher with more extensive tumor, measured by either the LD-ED or TNM staging. High LDH predicted poorer responses to chemotherapy and lower survival within similar stage subgroups compared to patients with normal LDH levels. The negative effect of elevated LDH was independent of hepatic involvement and did not predict subsequent hepatic failure in any consistent way. The SCCL TNM staging system proposed needs further refinement and should be tested with larger patient numbers. LDH, along with other tumor markers recently identified, need to be integrated into the staging system to form an overall prognostic index.

Long-term survival in small-cell carcinoma of the lung: A population experience

Long-term survival in small-cell carcinoma of the lung: A population experience

Long-term survival in small-cell carcinoma of the lung: a population experience.

Small-cell lung carcinoma (SCLC) is a rapidly progressive and fatal disease. Historically, surgical resection or radiotherapy of the primary tumor has done little to prolong survival, although the use of combination chemotherapy is more effective. Reported here is the survival experience of 1,538 incident cases of SCLC identified through the Surveillance, Epidemiology and End Results Program in western Washington State from 1974 to 1982. The survival experience of this population series is similar to that reported from specialized referral centers. For 71 of 78 persons surviving at least 24 months, the original diagnostic slides were independently reviewed, 47 cases being confirmed as SCLC. No differences were found in actuarial survival estimates between those confirmed and those not confirmed as SCLC. Multivariate survival analysis was conducted to estimate the effects on survival of stage, therapy, age, sex, primary site, and histologic type. All factors except primary site and histologic type significantly influence initial survival rates. However, the only factor related to post--two-year (ie, long-term) survival, once stage is accounted for, is whether surgery was received as a first course of therapy. Those not receiving surgery were at four times the risk of death as those who did. These results indicate that long-term survival can be achieved in patients with SCLC treated in the community, and that the chance of surviving an additional two years for such patients is approximately 40%.

Management of hematologic and infectious complications of intensive induction therapy for small cell carcinoma of the lung

In an effort to improve response rate and survival in small cell carcinoma of the lung, considerable attention has been focused on induction therapy with intensive chemotherapeutic regimens. The morbidity and mortality of such therapeutic programs have been of considerable concern. The hematologic and infectious complications of highly intensive induction chemotherapy in 72 patients with small cell lung cancer treated at the Johns Hopkins Oncology Center were reviewed, and guidelines for the management of aplasia in this patient population are suggested. Bone marrow aplasia was severe, with 90 percent of 140 cycles of therapy associated with the development of fever. However, during only 20 percent of febrile episodes could a specific site of infection or pathogen be identified. Prophylactic platelet transfusions were administered during 42 percent of courses because of severe thrombocytopenia (platelet count below 20,000/mm 3). Only a single significant bleeding episode developed during therapy. The occurrence of bacteremia (9.3 percent of cycles) was strongly associated with the development of severe thrombocytopenia. There were no deaths during aplasia. It is concluded that intensive combination chemotherapy can be safely administered to this elderly patient population with acceptable morbidity provided there is strict adherence to the unique principles of antibiotic usage and platelet support during bone marrow aplasia.

Effect of warfarin on survival in small cell carcinoma of the lung. Veterans Administration Study No. 75

In a controlled, randomized study, survival of patients with small cell carcinoma of the lung (SCCL) was prolonged on addition of warfarin sodium to combination chemotherapy plus radiation therapy. Median survival for 25 control patients was 24 weeks and for 25 warfarin-treated patients was 50 weeks. This difference could not be accounted for by differences between groups in performance status, extent of disease, age, or sex. The survival advantage associated with warfarin administration was observed both for patients with extensive disease and for those who failed to achieve complete or partial remission. The warfarin-treated group also demonstrated a significantly increased time to first evidence of disease progression. These results suggest that warfarin may be useful in the treatment of SCCL and also support the hypothesis that the blood coagulation mechanism may be involved in the growth and spread of cancer in man. (<i>JAMA</i>1981;245:831-835)

Effect of Warfarin on Survival in Small Cell Carcinoma of the Lung

In a controlled, randomized study, survival of patients with small cell carcinoma of the lung (SCCL) was prolonged on addition of warfarin sodium to combination chemotherapy plus radiation therapy. Median survival for 25 control patients was 24 weeks and for 25 warfarin-treated patients was 50 weeks. This difference could not be accounted for by differences between groups in performance status, extent of disease, age, or sex. The survival advantage associated with warfarin administration was observed both for patients with extensive disease and for those who failed to achieve complete or partial remission. The warfarin-treated group also demonstrated a significantly increased time to first evidence of disease progression. These results suggest that warfarin may be useful in the treatment of SCCL and also support the hypothesis that the blood coagulation mechanism may be involved in the growth and spread of cancer in man.

Long-term survival in small cell carcinoma of the lung

From June 1973 to August 1977, three hundred thirty-seven patients with small cell carcinoma of the lung were included in randomized therapeutic trials. By February 1979, fifty-one patients (15%) had survived for 18 months, including 29 (9%) in clinical complete remission. Of the latter patients, readmitted for restaging, including bone marrow examination, peritoneoscopy, and bronchomediastinoscopy, residual tumor was found in four. Treatment was discontinued in the remaining patients; six subsequently had relapses, while three patients died, free of disease, of other causes. Sixteen patients are still alive and free of disease more than 19 to 50 months after the primary diagnosis; seven were treated with combination chemotherapy alone, including four who initially had distant metastatic disease. The remaining nine patients had regional disease and were treated with both chemotherapy and radiotherapy, including prophylactic brain irradiation in four patients. Long-term survival can be achieved in a small number of patients in all stages of small cell carcinoma with intensive combination chemotherapy. (<i>JAMA</i>244:247-250, 1980)

Long-term Survival in Small Cell Carcinoma of the Lung

From June 1973 to August 1977, three hundred thirty-seven patients with small cell carcinoma of the lung were included in randomized therapeutic trials. By February 1979, fifty-one patients (15%) had survived for 18 months, including 29 (9%) in clinical complete remission. Of the latter patients, readmitted for restaging, including bone marrow examination, peritoneoscopy, and bronchomediastinoscopy, residual tumor was found in four. Treatment was discontinued in the remaining patients; six subsequently had relapses, while three patients died, free of disease, of other causes. Sixteen patients are still alive and free of disease more than 19 to 50 months after the primary diagnosis; seven were treated with combination chemotherapy alone, including four who initially had distant metastatic disease. The remaining nine patients had regional disease and were treated with both chemotherapy and radiotherapy, including prophylactic brain irradiation in four patients. Long-term survival can be achieved in a small number of patients in all stages of small cell carcinoma with intensive combination chemotherapy.

Lung Cancer

Only patients with localized lung cancer benefit from curative resection. Curative radiotherapy is recommended in patients with a resectable tumor in whom surgery is precluded for medical reasons. Adjuvant preoperative or postoperative therapy of any type does not improve the results of surgery except in patients with Pancoast tumor. Therapy for nonlocalized tumors does not affect survival. Radiotherapy has a palliative effect in 50 to 75 per cent of patients presenting with symptoms from either a primary lesion or metastases and should therefore be recommended in symptomatic patients. The palliative effect of chemotherapy is limited in lung cancers other than small cell carcinomas. However, chemotherapy alone or in association with radiotherapy produces remarkable tumor regression and some improvement of survival in small cell carcinoma. The use of immunotherapy in the treatment of lung cancer is still under evaluation.