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Clinical Significance of Downstaging in Patients With Limited-Disease Small-Cell Lung Cancer

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Authors
Go, Se-Il; Keam, Bhumsuk; Kim, Tae Min; Lee, Se-Hoon; Kim, Dong-Wan; Kim, Hak Jae; Wu, Hong-Gyun; Chung, Doo Hyun; Heo, Dae Seog
Issue Date
2014-03
Citation
Clinical Lung Cancer, Vol.15 No.2, pp.E1-E6
Keywords
Nodal clearanceOverall survivalPartial responsePrognosisTumor burden
Abstract
Patients with limited-disease small-cell lung cancer (LD-SCLC) who do not achieve complete response after first-line treatment have a considerable relapse rate. This study assessed the effect of downstaging in 210 patients with LD-SCLC who received first-line treatment. Downstaging resulted in longer overall survival (OS) for the entire patient group, but particularly for patients who achieved a partial response (PR). Background: We investigated the effect of downstaging on OS in LD-SCLC patients treated with first-line treatment. Patients and Methods: We retrospectively reviewed 210 LD-SCLC patients who were treated with first-line treatment at Seoul National University Hospital between April 1999 and November 2012. Compared with initial tumor, node, metastases (TNM) stage, cases that showed a lower TNM stage after treatment were defined as 'downstaging.' The relationship between downstaging and OS was analyzed, and a subgroup analysis on the responders was performed. Results: After first-line treatment, 78 (37.1%) patients achieved complete response, 97 (46.2%) achieved PR, and 35 (16.7%) experienced stable disease or progressive disease. A hundred and fifty one patients (71.9%) showed downstaging of their diseases, and the remaining 59 patients (28.1%) showed no change or upstaging. The median OS for patients achieving downstaging and no change/upstaging were 32.8 months and 13.1 months, respectively (P <.001). Of the 97 patients who achieved PR, the OS was significantly longer in patients who showed downstaging than those who did not (25.8 months vs. 13.8 months, respectively; P = .004). In multivariate analyses, female sex, downstaging, lower initial TNM stage, and prophylactic cranial irradiation were independent good prognostic factors for OS. Conclusion: Downstaging might be an independent good prognostic factor in LD-SCLC. Specifically, downstaging is expected to be useful for stratification of patients achieving PR. Further prospective studies are warranted to verify whether patients who achieved PR without downstaging can be candidates for consolidation treatments after first-line treatment. (C) 2014 Elsevier Inc. All rights reserved.
ISSN
1525-7304
URI
https://hdl.handle.net/10371/165394
DOI
https://doi.org/10.1016/j.cllc.2013.09.003
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College of Medicine/School of Medicine (의과대학/대학원)Cancer Research Institute (암연구소)Journal Papers (저널논문_암연구소)
College of Medicine/School of Medicine (의과대학/대학원)Internal Medicine (내과학전공)Journal Papers (저널논문_내과학전공)
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