Satoshi Igawa1, Katsuhiko Naoki2, Yasushi Shintani3, Ikuo Sekine4, Takehito Shukuya5, Koichi Takayama6, Akira Inoue7, Isamu Okamoto8, Katsuyuki Kiura9, Kazuhisa Takahashi5, Nobuyuki Yamamoto10, Yuichi Takiguchi11, Etsuo Miyaoka12, Meinoshin Okumura13, Ichiro Yoshino14. 1. Department of Respiratory Medicine, Kitasato University School of Medicine, Kanagawa, Japan. Electronic address: igawa@kitasato-u.ac.jp. 2. Department of Respiratory Medicine, Kitasato University School of Medicine, Kanagawa, Japan. 3. Department of General Thoracic Surgery, Osaka University Graduate School of Medicine, Osaka, Japan. 4. Department of Medical Oncology, Faculty of Medicine, University of Tsukuba, Tsukuba, Japan. 5. Department of Respiratory Medicine, Juntendo University Graduate School of Medicine, Tokyo, Japan. 6. Department of Pulmonary Medicine, Kyoto Prefectural University of Medicine, Kyoto, Japan. 7. Department of Palliative Medicine, Tohoku University School of Medicine, Miyagi, Japan. 8. Research Institute for Diseases of the Chest, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan. 9. Department of Allergy and Respiratory Medicine, Okayama University Hospital, Okayama, Japan. 10. Internal Medicine III, Wakayama Medical University, Wakayama, Japan. 11. Department of Medical Oncology, Graduate School of Medicine, Chiba University, Chiba, Japan. 12. Department of Mathematics, Science University of Tokyo, Tokyo, Japan. 13. Department of General Thoracic Surgery, National Hospital Organization Toneyama Hospital, Osaka, Japan. 14. Department of General Thoracic Surgery, Graduate School of Medicine, Chiba University, Chiba, Japan.
Abstract
OBJECTIVES: Most patients with small-cell lung cancer (SCLC) experience relapse because of the emergence of drug-resistant tumor cells. Therefore, second-line therapy is subsequently required to prolong their survival. However, it is unclear whether second-line chemotherapy can provide a survival benefit to elderly patients with relapsed SCLC. Therefore, this study aimed to evaluate survival and identify prognostic factors in an elderly population. MATERIALS AND METHODS: Based on a nationwide registry database of patients with SCLC (the Japanese Joint Committee of Lung Cancer Registry), we retrospectively reviewed medical records of patients aged ≥ 75 years with relapsed SCLC who subsequently received second-line chemotherapy. Survival time since the initiation of second-line chemotherapy was evaluated. RESULTS: Among 731 patients aged ≥ 75 years with SCLC who were accumulated by the nationwide registry database, this study included 228 patients, comprising 190 men and 38 women with a median age of 78 years. The number of patients with performance status (PS) of 0-1 and 2-4 was 196 and 32, respectively. The overall survival (OS) and 1-year survival rates were 7.5 months and 24 %, respectively. A multivariate analysis identified PS, clinical stage at the time of starting first-line therapy, and the interval from the start of first-line therapy to that of second-line therapy as independent prognostic factors. CONCLUSION: This study with the nationwide registry database showed that among the relapsed elderly SCLC patients who received second-line chemotherapy, a substantial OS may be expected in patients with good PS, at an early clinical stage at the time of starting first-line therapy, and with a longer interval from the start of first-line therapy to that of second-line chemotherapy.
OBJECTIVES: Most patients with small-cell lung cancer (SCLC) experience relapse because of the emergence of drug-resistant tumor cells. Therefore, second-line therapy is subsequently required to prolong their survival. However, it is unclear whether second-line chemotherapy can provide a survival benefit to elderly patients with relapsed SCLC. Therefore, this study aimed to evaluate survival and identify prognostic factors in an elderly population. MATERIALS AND METHODS: Based on a nationwide registry database of patients with SCLC (the Japanese Joint Committee of Lung Cancer Registry), we retrospectively reviewed medical records of patients aged ≥ 75 years with relapsed SCLC who subsequently received second-line chemotherapy. Survival time since the initiation of second-line chemotherapy was evaluated. RESULTS: Among 731 patients aged ≥ 75 years with SCLC who were accumulated by the nationwide registry database, this study included 228 patients, comprising 190 men and 38 women with a median age of 78 years. The number of patients with performance status (PS) of 0-1 and 2-4 was 196 and 32, respectively. The overall survival (OS) and 1-year survival rates were 7.5 months and 24 %, respectively. A multivariate analysis identified PS, clinical stage at the time of starting first-line therapy, and the interval from the start of first-line therapy to that of second-line therapy as independent prognostic factors. CONCLUSION: This study with the nationwide registry database showed that among the relapsed elderly SCLCpatients who received second-line chemotherapy, a substantial OS may be expected in patients with good PS, at an early clinical stage at the time of starting first-line therapy, and with a longer interval from the start of first-line therapy to that of second-line chemotherapy.