In order to personalize multimodal treatment regimens in limited-stage small cell lung cancer (LS-SCLC), a survival score for these patients was proposed. The aim of this study is to validate the score in an independent external patient cohort.
We collected data of 78 patients treated with chemoradiotherapy for LS-SCLC between 2004 and 2015. The survival score was calculated by independent prognostic factors: gender, Karnofsky performance status, tumor substage, and hemoglobin level before treatment. Scoring points were derived from 2-year survival rates divided by 10 and the values for each prognostic factor were tallied. Three risk subgroups were defined (high, intermediate, low risk: 9–13, 14–18, 19–26 points). The 2-year survival rate of each subgroup from the original study was compared to its corresponding subgroup from the validation cohort.
Median survival time in the entire validation cohort was 17 months (range: 1–123 months). The 2-year survival rates were 0% in the 9–13, 35% in the 14–18, and 43% in the 19–26 points group, respectively (p = 0.018). The difference in 2-year survival between the 9–13 points and the 14–18 points group was significant in the validation cohort (p = 0.007) as well after stratification of concurrent chemoradiotherapy (p < 0.001), whereas the difference between the 14 and 18 points and the 19–26 points group was not significant (p = 0.602, p = 0.770).
The score was reproducible to estimate the 2-year survival rate of patients with LS-SCLC, especially in the high- and intermediate-risk subgroups. In order to improve the differentiation between patients with an intermediate and favorable survival prognosis, the scoring system needs further development.
This is a preview of subscription content, log in to check access.
Buy single article
Instant access to the full article PDF.
Price includes VAT for USA
Subscribe to journal
Immediate online access to all issues from 2019. Subscription will auto renew annually.
This is the net price. Taxes to be calculated in checkout.
Siegel RL, Miller KD, Jemal A (2016) Cancer statistics, 2016. CA: A Cancer J Clin 66:7–30
Nicholson AG, Chansky K, Crowley J, Beyruti R, Kubota K, Turrisi A, Eberhardt WE, Van Meerbeeck J, Rami-Porta R, Goldstraw P (2016) The International Association for the Study of Lung Cancer Lung Cancer Staging Project: proposals for the revision of the clinical and pathologic staging of small cell lung cancer in the forthcoming eighth edition of the TNM classification for lung cancer. J Thoracic Oncol 11:300–311
Käsmann L, Niyazi M, Blanck O, Baues C, Baumann R, Dobiasch S, Eze C, Fleischmann D, Gauer T, Giordano FA (2017) Predictive and prognostic value of tumor volume and its changes during radical radiotherapy of stage III non-small cell lung cancer. Prädiktiver und prognostischer Wert des Tumorvolumens und seiner Veränderungen während radikaler Strahlentherapie beim nicht-kleinzelligen Bronchialkarzinom im Stadium III. Strahlenther Onkol 194(2):79–90
Pietanza MC, Byers LA, Minna JD, Rudin CM (2015) Small cell lung cancer: will recent progress lead to improved outcomes? Clin Cancer Res 21:2244–2255
Früh M, De Ruysscher D, Popat S, Crino L, Peters S, Felip E, ESMO Guidelines Working Group (2013) Small-cell lung cancer (SCLC): ESMO clinical practice guidelines for diagnosis, treatment and follow-up. Ann Oncol 24:vi99–vi105
Murray N, Coy P, Pater JL, Hodson I, Arnold A, Zee B, Payne D, Kostashuk E, Evans W, Dixon P (1993) Importance of timing for thoracic irradiation in the combined modality treatment of limited-stage small-cell lung cancer. The National Cancer Institute of Canada Clinical Trials Group. J Clin Oncol 11:336–344
Chen Y, Li J, Zhang Y, Hu Y, Zhang G, Yan X, Lin Z, Zhao Z, Jiao S (2018) Early versus late prophylactic cranial irradiation in patients with extensive small cell lung cancer. Strahlenther Onkol 194(10):876–885
Eze C, Käsmann L, Manapov F (2019) Redefining the role of prophylactic cranial irradiation in the modern era of active surveillance in small cell lung cancer. JAMA Oncol 5:11–12
Eze C, Roengvoraphoj O, Niyazi M, Hildebrandt G, Fietkau R, Belka C, Manapov F (2017) Treatment response and prophylactic cranial irradiation are prognostic factors in a real-life limited-disease small-cell lung cancer patient cohort comprehensively staged with cranial magnetic resonance imaging. Clin Lung Cancer 18:e243–e249
Eze C, Roengvoraphoj O, Dantes M, Abdo R, Kaesmann L, Schmidt-Hegemann N-S, Belka C, Manapov F (2018) Prophylactic cranial irradiation for patients with small cell lung cancer in Germany: pattern of care survey. Anticancer Res 38:5261–5265
Abdel-Rahman O (2018) Outcomes of surgery as part of the management of metastatic non–small-cell lung cancer: a surveillance, epidemiology and end results database analysis. Cancer Investig 36:238–245
Kaesmann L, Janssen S, Rades D (2016) Karnofsky performance score, radiation dose and nodal status predict survival of elderly patients irradiated for limited-disease small-cell lung cancer. Anticancer Res 36:4177–4180
Roengvoraphoj O, Eze C, Niyazi M, Li M, Hildebrandt G, Fietkau R, Belka C, Manapov F (2017) Prognostic role of patient gender in limited-disease small-cell lung cancer treated with chemoradiotherapy. Strahlenther Onkol 193:150–155
Svensson G, Ewers S, Ohlsson O, Olsson H (2013) Prognostic factors in lung cancer in a defined geographical area over two decades with a special emphasis on gender. Clin Respir J 7:91–100
Abdel-Rahman O (2018) Impact of baseline characteristics on extensive-stage SCLC patients treated with etoposide/carboplatin: a secondary analysis of a phase III study. Clin Respir J 12:2519–2524
Chen Y, Li J, Hu Y, Zhang Y, Lin Z, Zhao Z, Jiao S (2016) Prophylactic cranial irradiation could improve overall survival in patients with extensive small cell lung cancer. Strahlenther Onkol 192:905–912
Rades D, Kaesmann L, Janssen S, Schild SE (2016) A new score for estimating survival after definitive radiochemotherapy of limited disease small cell lung cancers. Lung 194:625–629
Takada M, Fukuoka M, Kawahara M, Sugiura T, Yokoyama A, Yokota S, Nishiwaki Y, Watanabe K, Noda K, Tamura T (2002) Phase III study of concurrent versus sequential thoracic radiotherapy in combination with cisplatin and etoposide for limited-stage small-cell lung cancer: results of the Japan Clinical Oncology Group Study 9104. J Clin Oncol 20:3054–3060
Turrisi AT, Kim K, Blum R, Sause WT, Livingston RB, Komaki R, Wagner H, Aisner S, Johnson DH (1999) Twice-daily compared with once-daily thoracic radiotherapy in limited small-cell lung cancer treated concurrently with cisplatin and etoposide. N Engl J Med 340:265–271
Weksler B, Nason KS, Shende M, Landreneau RJ, Pennathur A (2012) Surgical resection should be considered for stage I and II small cell carcinoma of the lung. Ann Thoracic Surg 94:889–893
Käsmann L, Bolm L, Schild SE, Janssen S, Rades D (2017) Neutrophil-to-lymphocyte ratio predicts outcome in limited disease small-cell lung cancer. Lung 195:217–224
Faivre-Finn C, Snee M, Ashcroft L, Appel W, Barlesi F, Bhatnagar A, Bezjak A, Cardenal F, Fournel P, Harden S (2017) Concurrent once-daily versus twice-daily chemoradiotherapy in patients with limited-stage small-cell lung cancer (CONVERT): an open-label, phase 3, randomised, superiority trial. Lancet Oncol 18:1116–1125
Rades D, Käsmann L, Schild SE, Janssen S (2016) A survival score for patients receiving palliative irradiation for locally advanced lung cancer. Clin Lung Cancer 17:558–562
Rades D, Veninga T, Bajrovic A, Karstens J, Schild S (2013) A validated scoring system to identify long-term survivors after radiotherapy for metastatic spinal cord compression. Strahlenther Onkol 189:462–466
Rades D, Douglas S, Schild S (2013) A validated survival score for breast cancer patients with metastatic spinal cord compression. Strahlenther Onkol 189:41–46
De Ruysscher D, Pujol J, Popat S, Reck M, Le Pechoux C, Liston A, Speiser D, Coukos G, Kammler R, Dafni O (2016) STIMULI: a randomised open-label phase II trial of consolidation with nivolumab and ipilimumab in limited-stage SCLC after standard of care chemo-radiotherapy conducted by ETOP and IFCT. Ann Oncol 27(6):493–496
The data were partly presented at the ELCC and ESTRO congress 2019.
Conflict of interest
On behalf of all authors, the corresponding author states that there is no conflict of interest/financial interest related to this study.
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
About this article
Cite this article
Käsmann, L., Abdo, R., Eze, C. et al. External Validation of a Survival Score for Limited-Stage Small Cell Lung Cancer Patients Treated with Chemoradiotherapy. Lung 198, 201–206 (2020). https://doi.org/10.1007/s00408-019-00312-6
- Prognostic factors