ABSTRACT
Objective To investigate the association between the timing of brain metastases and the prognosis of patients with small cell lung cancer (SCLC).Methods A retrospective analysis was performed in 131 patients with limited-stage SCLC firstly metastasized to the brain were admitted to our hospital from 2007 to 2015.According to the median bone metastasis-free survival (BMFS),all patients were divided into A group (BMFS ≤ 10 months,n =61) and B group (BMFS＞ 10 months,n=70).The survival rates were analyzed using the Kaplan-Meier method.Between-group comparison was performed by log-rank test.The Cox regression model was used for multivariate prognostic analysis.Results In all 131 patients,the median overall survival (OS) and 1-,2-,and 3-year OS rates were 22.5 months,87.3％,44.7％,and 20.8％,respectively.The median OS after brain metastases and 1-and 2-year OS rates were 9.3 months,39.3％ and 14.8％,respectively.No statistical significance was observed in the median OS after brain metastases between the A and B groups (8.6 vs.9.3 months,P=0.695).Moreover,the OS after brain metastases did not significantly differ in patients without PCI or those receiving different therapies after brain metastases between two groups (P=0.240-0.731).Conclusions The timing of SCLC with brain metastases is significantly correlated with the OS rather than the OS after brain metastases.Therefore,prevention of brain metastases may be an effective approach to prolong the OS of patients with SCLC.
ABSTRACT
Objective To investigate the optimal dosage of thoracic radiotherapy in patients diagnosed with extensive stage small cell lung cancer (ES-SCLC).Methods Clinical data of ES-SCLC patients admitted to Tianjian Medical University Cancer Institute& Hospital between February 2010 and October 2015 were retrospectively analyzed.All patients received the first-line induction chemotherapy.Subsequently,216 patients without progression after the first-line induction chemotherapy were apportioned to the thoracic radiotherapy (n=180) group and chemotherapy alone group (n=36).According to the distribution characteristics of the biological equivalent dose,all patients were assigned into the A (31.3-40.2 Gy,n=23),B (46.0-46.8 Gy,n=38),C (49.5-53.7 Gy,n=43) and D groups (55.1-60.6 Gy,n=76).For the subgroup analysis,the low (31.3-46.8 Gy,n=61) and high dose groups (49.5-60.6 Gy,n=119) were divided.Kaplan-Meier survival analysis was used for prognostic analysis.Cox's regression model was conducted for multivariate prognostic analysis.Propensity score matching was utilized to control the confounding variables.Results The median overall survival of all patients was 13.2 months,and 8.3,11.0,15.8,17.8 and 8.1 months for patients in the A,B,C,D and chemotherapy alone groups,respectively (all P=0.000).The median overall survival did not significantly differ between A and B/ chemotherapy groups (P=0.172,P=0.495),and similar results were obtained between the C and D groups (P=0.624).The median overall survival in the B group was significantly longer than that in the chemotherapy alone group (P=0.020).Statistical significance was noted between C and D groups,and A and B groups (all P＜0.05).The median progression-free survival for all patients was 8.7 months,and 6.5,7.6,11.8,12.4 and 6.1 months in the A,B,C,D and chemotherapy alone groups,respectively (all P=0.000).The median progression-free survival did not significantly differ between A and B chemotherapy groups (P=0.588,P=0.668).The progression-free survival in the B group was slightly longer than that in the chemotherapy group without statistical significance (P=0.070).No statistical significance was observed between the C and D groups (P=0.627).Statistical significance was noted between C and D groups,and A and B groups (all P＜0.02).Uni-and multi-variate analyses prompted that the number of metastatic lesions and dose of thoracic radiotherapy were the independent predictors of the overall survival and progression-free survival (both P＜0.05).Concurrent chemoradiotherapy was the independent predictor of the overall survival (P=0.018).After the propensity score matching,the median overall survival and progression-free survival significantly differed between the low (n=50) and high dose groups (n=50) (10.9 vs.17.5 months,P=0.045;7.4 vs.10.7 months,P=0.014).Conclusions A relatively high dose ranging from 49.5 to 53.7 Gy is recommended during thoracic radiotherapy for ES-SCLC patients.An excessively low dose (≤ 40.2 Gy) probably fails to prolong the survival time,and an extremely high dose (≥55.1 Gy) cannot enable the patients to obtain survival benefits.
ABSTRACT
Objective@#To explore the effect of nutritional status pre-and during chemoradiotherapy on the prognosis of patients with limited- stage small cell lung cancer (LS-SCLC).@*Methods@#We retrospectively collected medical records of 172 LS-SCLC patients undergoing concurrent chemoradiotherapy in our hospital from 2000 to 2014, with 126 males and 46 females. The data of complete blood count and hepatic and renal function were collected before initial treatment, before radiotherapy, 4 weeks during radiotherapy, and 1 month after complete of treatment. The prognostic nutritional index(PNI)was calculated. Kaplan-Meier method was used to calculate the survival rate. Log-rank test was performed used to compare the survival differences between groups. Multivariate prognostic analysis was performed using Cox regression model.@*Results@#The median overall survival (OS) was 21 months, with median progression-free survival (PFS) of 11 months. At the beginning of treatment, patients with pre-treatment PNI ≥ 53 had significantly superior OS (median 37 vs 15 months, P=0.001) and PFS (median 16 vs 10 months, P=0.017). Patients with pre-treatment hemoglobin ≥140 g/L and <140 g/L had an median OS of 32 months and 17 months (P=0.019), and median PFS of 16 months and 9 months (P=0.040), respectively. During chemoradiation, patients with elevated hemoglobin had similar median OS compared with those had decreased hemoglobin (27 vs 18 months, P=0.063, but superior median PFS (15 vs 9 months, P=0.017). Multivariate analysis revealed that prophylactic cranial irradiation, pre-treatment hemoglobin ≥140 g/L, and pretreatment PNI ≥53 were independent predictors of OS and PFS in patients with LS-SCLC.@*Conclusion@#Pre-treatment nutritional status and the changes of nutritional status during chemoradiotherapy is significantly associated with the prognosis of patients with limited-stage small cell lung cancer. The patients with better pre-treatment nutritional status have a better prognosis.
ABSTRACT
BACKGROUND@#Malignant pleural effusion (PE) was generally defined as pleural effusion containing tumors with poor prognosis. Some kinds of undefined pleural effusions due to too small amount of effusion had poor prognosis too. This study aimed to analyze the clinical characteristics and prognostic factors of patients who suffered from limited-stage small cell lung cancer (LS-SCLC) complicated with pleural effusion.@*METHODS@#A retrospective analysis included 542 patients who were diagnosed with LS-SCLC and had treatment in our hospital from October 2007 to January 2016. We had observed 109 patients who were diagnosed with pleural effusion at their first visit to the doctor. We analyzed the clinical characters, survival time and the prognostic factors of the 109 patients. Our main observation targets were overall survival (OS) and progression free survival (PFS).@*RESULTS@#The median OS and PFS of whole group were 29.4 and 18.2 months. Before treatment, survival time of patients with PE were significantly shorter than patients without PE (median OS: 21.0 vs 31.7 months; median PFS: 14.1 vs 9.1 months; Log-rank, P=0.001, P=0.014). Multi-factor analysis of multivariate Cox shows PE was the independent prognostic factor of LS-SCLC (P=0.04). Single factor analysis showed factors affecting PE patient's survival time included clinical stages, lymph node (LN) stages, KPS scores, pulmonary atelectasis and the state of pleural after treatment. Cox multi-factor analysis reminded that the state of pleural effusion after treatment was the independent prognostic factor of LS-SCLC complicated with pleural effusion (P=0.016). There were three groups was apportioned patients without pleural effusion before treatment (group 1; n=433), patients whose pleural effusion disappeared after treatment (group 2; n=67) and patients whose pleural effusion didn't disappear after treatment (group 3; n=32).The median OS were 31.7, 23.2, 16.8 months in the group 1, 2, 3 and the median PFS were 19.1, 17.9, 11.4 months. Obvious difference was noted by the comparison of survival time of these three groups (Log-rank P<0.001, P<0.002). The difference between group 2 and group 3 was significant (Log-rank P=0.046, P=0.013) while no obvious difference was noted during comparison of group 1 and group 2. For patients who have LS-SCLC complicated with PE, there is no remarkable difference between chemoradiotherapy and chemotherapy alone.@*CONCLUSIONS@#The survival time of patients who suffered from limited-stage small cell lung cancer complicated with pleural effusion was obviously shortened. The disappearing of pleural effusion after treatment was the independent favorable prognostic factor of survival. How to treat needed further investigation.
Subject(s)
Aged , Female , Humans , Male , Middle Aged , Follow-Up Studies , Lung Neoplasms , Diagnosis , Pathology , Multivariate Analysis , Neoplasm Staging , Pleural Effusion , Prognosis , Retrospective Studies , Small Cell Lung Carcinoma , Diagnostic Imaging , PathologyABSTRACT
Objective To investigate the effect of the timing of radiotherapy on the prognosis of limited-stage small cell lung cancer (LS-SCLC) in the elderly. Methods A retrospective analysis was performed on the clinical data of 80 elderly patients with LS-SCLC who were treated with radical sequential thoracic chemoradiotherapy from 2008 to 2014.The correlations of SER(time from the start of any treatment to the end of radiotherapy) and the number of induction chemotherapy cycles with overall survival(OS) and progression-free survival (PFS) rates was analyzed. The treatment outcomes were compared between early radiotherapy group (no later than 3 cycles of induction chemotherapy,n=37) and late radiotherapy group (after 3 cycles of induction chemotherapy,n=43).The Kaplan-Meier method was used for survival analysis. Results In all patients,the median OS and PFS were 23.5 and 13.3 months respectively. SER was significantly correlated with OS and PFS (P=0.001;P=0.001).The median OS in patients undergoing radiotherapy after 2,3,4,5,and 6 cycles of induction chemotherapy was 33.2,26.7,20.6,16.9,and 17.9 months (P=0.000),respectively. The median OS time and 1-,2-,and 5-year OS rates were 27.8 months, 87%,62%,and 34%,respectively,in the early radiotherapy group,and 17.9 months,74%,37%,and 15%, respectively,in the late radiotherapy group (P=0.017).The median PFS time and 1-,2-,and 5-year PFS rates were 17.1 months,65%,43%,and 28%,respectively,in the early radiotherapy group,and 11.9 months,49%,21%,and 14%,respectively,in the late radiotherapy group( P= 0.022). Conclusions Shorter SER achieves better treatment outcomes in elderly patients with LS-SCLC undergoing sequential chemoradiotherapy. Early radiotherapy provides a survival benefit for patients.
ABSTRACT
As a newly identified T helper cell subset, Th9 plays an important role in anti-tumor immunity. Th9 can be differentiated from CD4+T cells that have been induced by TGF-beta and IL-4. In addition, other CD4+T helper cell subsets can be developed to Th9 cell in particular situations, thereby showing its plasticity. Results of animal experiments have indicated that Th9 inhibits tumor growth and plays a significant role in anti-tumor immunity by secreting related cytokines such as IL-9. A few cytokines and molecules can regu-late the differentiation and development of Th9 cells in different signaling pathways. This review will focus on the production, anti-tu-mor immunity, related mechanism, and signaling pathways of Th9 cells, thereby providing a new field of vision and idea for anti-tumor therapy in the future.