Real-World Analysis of Treatment Patterns in Limited-Stage Small Cell Lung Cancer: Implications for Clinical Practice.

Abstract

Background: Unresolved issues complicate treating limited-stage small-cell lung cancer (LS-SCLC). We conducted a real-world study analyzing LS-SCLC treatment patterns to address clinical needs.

Methods: We retrospectively enrolled patients with LS-SCLC treated at Peking Union Medical College Hospital between May 2008 and December 2023. Information was collected on clinicopathological features, cancer-related treatments, laboratory test results, and clinical and prognostic data. Kaplan-Meier survival analysis was performed to evaluate progression-free (PFS) and overall survival (OS). Cox regression models were used to assess the factors influencing survival.

Results: Among the 203 patients with LS-SCLC, the median OS (mOS) was 28.8 months. Log-rank testing revealed significant mOS differences among radiotherapy timing groups (p = 0.031): concurrent chemoradiotherapy (cCRT) 30.1 months, sequential therapy 27.5 months, and no radiotherapy 21.7 months. Early cCRT showed a non-significant mOS trend advantage over late cCRT (38.3 vs. 29.5 months, p = 0.058). Prophylactic cranial irradiation (PCI) demonstrated comparable mOS (36.9 vs. 29.6 months, p = 0.27). Peripheral blood biomarkers (PBBs) lacked prognostic significance. Multivariate analysis identified Eastern Cooperative Oncology Group (ECOG) performance status (PS) > 1 (HR = 3.652, 95% CI 1.579-8.448; p = 0.002) and N2/N3 metastasis (N2: HR = 2.872, 95% CI 1.312-6.286, p = 0.008; N3: HR = 2.645, 95% CI 1.195-5.856, p = 0.016) as survival predictors. Sequential radiotherapy increased mortality risk versus early cCRT (HR = 1.701, 95% CI 1.125-2.573; p = 0.012).

Conclusions: Performance status and lymph node metastasis are prognostic factors for patients with LS-SCLC. cCRT improves the prognosis of LS-SCLC, with early cCRT providing a significant survival benefit and late cCRT being an acceptable option.