Predictors of febrile neutropenia in small cell lung cancer patients receiving concurrent chemoradiotherapy with etoposide and cisplatin: a focus on nutritional status, inflammation, and performance status.

Abstract

Small cell lung cancer (SCLC) is a rapidly proliferating malignancy with a poor prognosis, commonly treated with concurrent chemoradiotherapy based on the etoposide and cisplatin (EP) regimen; however, this treatment is often complicated by febrile neutropenia (FN), a potentially life-threatening condition that can compromise treatment efficacy and patient safety. The aim of this study was to identify risk factors for FN in SCLC patients undergoing EP-based concurrent chemoradiotherapy to enhance treatment outcomes and improve patient management. In this retrospective case-control study, data from 216 SCLC patients who underwent concurrent chemoradiotherapy with the EP regimen between September 2014 and January 2020 were analyzed. Patients were categorized into FN (n = 106) and non-FN (n = 110) groups. Various clinical factors, including body mass index (BMI), Eastern Cooperative Oncology Group Performance Status (ECOG PS), and pre-treatment laboratory values such as albumin, IL-6, and C-reactive protein (CRP), were examined. Statistical analyses, including univariate and multivariate logistic regression, were performed to identify independent risk factors for FN. Lower BMI (P = 0.016) and poorer ECOG Performance Status (P = 0.001) were associated with an increased risk of FN. Additionally, pre-albumin levels (P = 0.010), inflammatory markers CRP (P = 0.032), and IL-6 (P = 0.001) also showed significant associations, suggesting that nutritional status and systemic inflammation play important roles in the development of FN. Importantly, multivariate logistic regression analysis confirmed pre-albumin levels (P = 0.003), IL-6 level (P = 0.001), MASCC score (P < 0.001), and ECOG PS (P = 0.019) as independent factors for FN risk. These findings highlight the importance of nutritional status, systemic inflammation, and overall health condition in predicting FN occurrence, underscoring the need for integrated risk assessment and management strategies to mitigate FN risk in SCLC patients undergoing EP-based concurrent chemoradiotherapy.