gms | German Medical Science

Background: Despite a high chemosensitivity, small cell lung carcinoma (SCLC) remains associated with a poor long term outcome. The purpose of this retrospective study was to identify predictive factors for overall survival of patients with SCLC undergoing first-line chemotherapy with a well established combination consisting of -Adriamycin, Cyclophosphamide and Etoposide (ACE).

Methods: Between 1989 and 2004 a total of 166 patients with SCLC were diagnosed and treated at one institution. Of those, n=134 patients were treated with first-line with chemotherapy; n=106 received ACE. The median follow-up was 7.5 years.

Results: Median overall survival (mOS) of patients receiving ACE was 9,36 months with median survival rates of 31, 8% and 3% after 1, 2 and 5 years, respectively. The following parameters were associated with significant differences in median overall survival (mOS) by univariate analysis: limited disease vs extended disease, p=0.022; ECOG-PS 0, I, II, III, p<0.001; White blood count (WBC) <10/nl vs>10/nl, p<0.001; Lactate dehydrogenase (LDH) <250 U/l vs >250 U/l, p=0.022. Gender, age and dose reduction during chemotherapy were not associated with differences in mOS. Using multivariate cox-regression analysis ECOG-PS (p=0.008) and WBC (p=0.022) were independent predictive factors for mOS. Three groups of outcome could be built with good, intermediate and poor prognosis resulting in mOS rates of 15.8, 6.87 and 3.35 months, respectively (p<0.0001).

Conclusions: (1) Survival rates of patients receiving ACE chemotherapy was similar as reported in the literature. (2) ECOG-PS and WBC, were independent predictive factors for outcome after long term follow-up. Patients with the poor prediction profile (ECOG-PS >0 and WBC >10/nl) will probably not benefit from ACE chemotherapy. However, this hypothesis has to be tested prospectively.

Figure 1 [Fig. 1]