Small cell carcinoma of the lung natural history, complications and prognosis

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [2]; Associate Editor(s)-in-Chief: Vendhan Ramanujam M.B.B.S [3]

Overview

The natural history of untreated small cell lung cancer (SCLC) is extremely poor, with median survival of only 2 months for stage IV SCLC and less than 3 to 4 months for tumors confined to the thorax.[1] With the current treatment modalities, the median survival of patients with limited stage disease ranges from 16 to 24 months while that of patients with extensive-stage disease ranges from 6 to 12 months.[2] SCLC can be complicated by paraneoplastic syndromes.

Natural History

Approximately 30% of patients with SCLC have limited stage disease which is characterized by a tumor confined to the hemithorax of origin, the mediastinum, or the supraclavicular lymph nodes. Patients with extensive-stage disease have tumors that have spread beyond the supraclavicular areas.[2]

Complications

Complications of the Disease Itself

Complications of the Treatment

Post operative complications following surgery include:[7]

Prognosis

Although for most patients with small cell carcinoma of lung the current treatment regimens do not provide cure, the potential prognostic factors that are considered to influence the prognosis of the disease, i.e. the chance of recovery and treatment options include the following.

Good Prognostic Factors

  • Limited stage disease: Limited stage disease is considered to be a good prognostic factor. With the current treatment modalities, the median survival of patients with limited stage disease ranges from 16 to 24 months. Some patients with limited-stage disease who might be eligible for surgery with or without adjuvant chemotherapy have an even a better prognosis.[2]
  • Absence of brain metastasis: Absence of metastasis in the brain at the time of diagnosis, together with a limited stage disease may be positive prognostic indicator.[8]
  • Young age: Young age at the time of diagnosis is considered as a favorable prognostic factor of the disease.[9]
  • Female sex: Diseased females live significantly longer than diseased males, thus serving as a positive prognostic factor.[9]
  • Asian ethnicity: Asian ethnicity carry a favorable prognosis.[10]
  • Normal white blood cell count: A normal white blood cell count is the most powerful positive prognostic indicator among laboratory values.[8]
  • Surgical resection, radiation, and chemotherapy: All treatment modalities like surgical resection,[11] radiation, and chemotherapy serve as favorable prognostic factors, contributing to the survival.[9]

Bad Prognostic Factors

  • Extent of the disease: Patients with extensive-stage disease have a worse prognosis than patients with limited-stage disease. With the current treatment modalities, the median survival for patients with extensive-stage disease ranges from 6 to 12 months and their long-term disease-free survival is rare.[2]
  • Cancer staging: TNM stage III (T1a: Tumor size 2 cm or less; N2: Metastasis in ipsilateral peribronchial and/or hilar lymph nodes and intrapulmonary nodes including involvement by direct extension; M0: No distant metastasis) and above has a bad prognosis on the progression of the disease.[8]
  • Age: Advanced age at the time of diagnosis is considered as a negative prognostic factor of the disease.[9]
  • Sex: Diseased males are associated with a worse survival.[9]
  • Socioeconomic status: Most of the patients are from the lower socioeconomic status and are unmarried. They have a poor prognosis when it comes to disease progression.[10]
  • Ethnicity: Hispanics and African Americas are significantly affected and they carry a poor prognosis.[10]
  • Performance status: Poor performance status is significantly associated with a reduced duration of survival.[9]
  • Smoking: A positive smoking history is a well known and established independent poor prognostic factor for small cell carcinoma of the lung.
  • Laboratory values: Albumin is an independent factor that can affect the prognosis of disease. Reduced hemoglobin concentration, and raised serum lactate dehydrogenase values have been demonstrated as factors that are associated with a significant reduction in the duration of survival following the disease.[9]

5-Year Survival

  • Between 2004 and 2010, the 5-year relative survival of patients with SCLC was 6.6%.[12]
  • When stratified by age, the 5-year relative survival of patients with SCLC was 8.4% and 4.7% for patients <65 and ≥ 65 years of age respectively.[12]
  • The survival of patients with SCLC varies with the stage of the disease. Shown below is a table depicting the 5-year relative survival by the stage of SCLC:[12]
Stage 5-year relative survival (%), (2004-2010)
All stages 6.3%
Localized 24.2%
Regional 14.3%
Distant 2.8%
Unstaged 7.8%

References

  1. Green, Robert A.; Humphrey, Edward; Close, Henry; Patno, Mary Ellen (1969). "Alkylating agents in bronchogenic carcinoma". The American Journal of Medicine. 46 (4): 516–525. doi:10.1016/0002-9343(69)90071-0. ISSN 0002-9343.
  2. 2.0 2.1 2.2 2.3 General Information About Small Cell Lung Cancer. National cancer institute. Accessed on June 17.[1]
  3. 3.0 3.1 3.2 3.3 3.4 3.5 Gandhi L, Johnson BE (2006). "Paraneoplastic syndromes associated with small cell lung cancer". J Natl Compr Canc Netw. 4 (6): 631–8. PMID 16813730.
  4. Radulescu D, Pripon S, Bunea D, Ciuleanu TE, Radulescu LI (2007). "Endocrine paraneoplastic syndromes in small cell lung carcinoma. Two case reports". J BUON. 12 (3): 411–4. PMID 17918299.
  5. 5.0 5.1 Elrington GM, Murray NM, Spiro SG, Newsom-Davis J (1991). "Neurological paraneoplastic syndromes in patients with small cell lung cancer. A prospective survey of 150 patients". J Neurol Neurosurg Psychiatry. 54 (9): 764–7. PMC 1014512. PMID 1659614.
  6. 6.0 6.1 6.2 6.3 6.4 Amir J, Galbraith RC (1992). "Paraneoplastic limbic encephalopathy as a nonmetastatic complication of small cell lung cancer". South Med J. 85 (10): 1013–4. PMID 1329233.
  7. Uramoto H, Nakanishi R, Fujino Y, Imoto H, Takenoyama M, Yoshimatsu T; et al. (2001). "Prediction of pulmonary complications after a lobectomy in patients with non-small cell lung cancer". Thorax. 56 (1): 59–61. PMC 1745907. PMID 11120906.
  8. 8.0 8.1 8.2 Brueckl WM, Herbst L, Lechler A, Fuchs F, Schoeberl A, Zirlik S; et al. (2006). "Predictive and prognostic factors in small cell lung carcinoma (SCLC)--analysis from routine clinical practice". Anticancer Res. 26 (6C): 4825–32. PMID 17214347.
  9. 9.0 9.1 9.2 9.3 9.4 9.5 9.6 Osterlind K, Andersen PK (1986). "Prognostic factors in small cell lung cancer: multivariate model based on 778 patients treated with chemotherapy with or without irradiation". Cancer Res. 46 (8): 4189–94. PMID 3015384.
  10. 10.0 10.1 10.2 Ou SH, Ziogas A, Zell JA (2009). "Prognostic factors for survival in extensive stage small cell lung cancer (ED-SCLC): the importance of smoking history, socioeconomic and marital statuses, and ethnicity". J Thorac Oncol. 4 (1): 37–43. doi:10.1097/JTO.0b013e31819140fb. PMID 19096304.
  11. Gaspar LE, McNamara EJ, Gay EG, Putnam JB, Crawford J, Herbst RS; et al. (2012). "Small-cell lung cancer: prognostic factors and changing treatment over 15 years". Clin Lung Cancer. 13 (2): 115–22. doi:10.1016/j.cllc.2011.05.008. PMID 22000695.
  12. 12.0 12.1 12.2 Howlader N, Noone AM, Krapcho M, Garshell J, Miller D, Altekruse SF, Kosary CL, Yu M, Ruhl J, Tatalovich Z,Mariotto A, Lewis DR, Chen HS, Feuer EJ, Cronin KA (eds). SEER Cancer Statistics Review, 1975-2011, National Cancer Institute. Bethesda, MD, http://seer.cancer.gov/csr/1975_2011/, based on November 2013 SEER data submission, posted to the SEER web site, April 2014.



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