Small cell lung cancer treatment and survival:
a retrospective study at a brazilian public cancer referral center
DOI:
https://doi.org/10.15448/1980-6108.2025.1.47468Keywords:
carcinoma, small cell lung, survival analysis, prognosis, retrospective studies.Abstract
Objective: To evaluate the characteristics, treatment received, survival, and prognostic factors of small cell lung cancer patients.
Methods: A retrospective cohort study was conducted at the reference a public cancer-center in Rio de Janeiro, Brazil. A total of 866 small cell lung cancer patients admitted in the period 2000-2020 participated in the study. Comparison between survival curves was performed by the log-rank test; variables whose p < 0.10 entered in the Cox regression models expressed as hazard ratios (HR) with 95% confidence intervals. The association between receiving best supportive care (none treatment) and admission period was evaluated by means of logistic regression.
Results: Median and 12-months survival were 6.2 and 23.7%, respectively. On multivariate Cox regression adjusted for treatment, poor (HR: 1.99; 1.57-2.51) and unknown performance status (HR: 2.79; 2.22-3.49), non-white skin color (HR: 1.25; 1.07-1.46), extensive (HR: 1.62; 1.29-2.04) and unknown staging (HR: 1.33; 1.07-1.65) remained associated with 12-months survival. Patients admitted during the last three admission period were nearly four times more likely to receive best supportive care in comparison to the first period.
Conclusion: The prognosis of small cell lung cancer is poor and the perspective toward increasing their survival is to improve the timely access to diagnosis and treatment.
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References
1. Mattiuzzi C, Lippi G. Current cancer epidemiology. J Epidemiol Glob Health. 2019;9(4):217-22. https://doi.org/10.2991/jegh.k.191008.001 DOI: https://doi.org/10.2991/jegh.k.191008.001
2. Rudin CM, Brambilla E, Faivre-Finn C, Sage J. Small-cell lung cancer. Nat Rev Dis Primers. 2021;7(1):3. https://doi.org/10.1038/s41572-020-00235-0 DOI: https://doi.org/10.1038/s41572-020-00235-0
3. Pesch B, Kendzia B, Gustavsson P, Jöckel KH, Johnen G, Pohlabeln H, et al. Cigarette smoking and lung cancer relative risk estimates for major histological types from a pooled analysis of case-control studies. Int J Cancer. 2012;131(5):1210-1219. https://doi.org/10.1002/ijc.27339 DOI: https://doi.org/10.1002/ijc.27339
4. Lim W, Ridge CA, Nicholson AG, Mirsadraee S. The 8th lung cancer TNM classification and clinical staging system: review of the changes and clinical implications. Quant Imaging Med Surg. 2018;8(7):709-718. https://doi.org/10.21037/qims.2018.08.02 DOI: https://doi.org/10.21037/qims.2018.08.02
5. Howlader N, Forjaz G, Mooradian MJ, Meza R, Kong CY, Cronin KA, et al. The effect of advances in lung-cancer treatment on population mortality. N Engl J Med. 2020;383(7):640-649. https://doi.org/10.1056/NEJMoa1916623 DOI: https://doi.org/10.1056/NEJMoa1916623
6. Bogart JA, Waqar SN, Mix MD. Radiation and systemic therapy for limited-stage small-cell lung cancer. J Clin Oncol. 2022;40(6):661-670. https://doi.org/10.1200/JCO.21.0163 DOI: https://doi.org/10.1200/JCO.21.01639
7. Tariq S, Kim SY, Novaes JMO, Cheng H. Update 2021: management of small cell lung cancer. Lung. 2021;199(6):579-587. https://doi.org/10.1007/s00408-021-00486-y DOI: https://doi.org/10.1007/s00408-021-00486-y
8. Rudin CM, Awad MM, Navarro A, Gottfried M, Peters S, Csőszi T, et al. Pembrolizumab or placebo plus etoposide and platinum as first-line therapy for extensive-stage small-cell lung cancer: randomized, double-blind, phase III KEYNOTE-604 study. J Clin Oncol. 2020;38(21):2369-2379. https://doi.org/10.1200/JCO.20.00793 DOI: https://doi.org/10.1200/JCO.20.00793
9. Malta DC, Gomes CS, Andrade FMD, Prates EJS, Alves FTA, Oliveira PPV, et al. Tobacco use, cessation, secondhand smoke and exposure to media about tobacco in Brazil: results of the National Health Survey 2013 and 2019. Rev bras epidemiol. 2021;24(suppl 2):e210006.supl.2. https://doi.org/10.1590/1980-549720210006.supl.2 DOI: https://doi.org/10.1590/1980-549720210006.supl.2
10. Organização Mundial da Saúde. Classificação Estatística Internacional de Doenças e Problemas Relacionados à Saúde. 10ª ed. São Paulo: Editora da Universidade de São Paulo; 2012.
11. Organização Mundial de Saúde. CID-O - Classificação Internacional de Doenças para Oncologia. 3ª ed. São Paulo: Editora da Universidade de São Paulo; 2013.
12. 5/08 - Mudanças no procedimento de primeira avaliação no INCA. Intranet INCA; Seção Últimas Notícias. Published 2013 (Aug 07).
13. The National Lung Screening Trial Research Team. Reduced lung-cancer mortality with low-dose computed tomographic screening. N Engl J Med. 2011;365:395-409. https://doi.org/10.1056/NEJMoa1102873 DOI: https://doi.org/10.1056/NEJMoa1102873
14. Debieuvre D, Molinier O, Falchero L, Locher C, Templement-Grangerat D, Meyer N, et al. Lung cancer trends and tumor characteristic changes over 20 years (2000-2020): results of three French consecutive nationwide prospective cohorts' studies. Lancet Reg Health Eur. 2022;22:100492. https://doi.org/10.1016/j.lanepe.2022.100492 DOI: https://doi.org/10.1016/j.lanepe.2022.100492
15. Barta JA, Powell CA, Wisnivesky JP. Global epidemiology of lung cancer. Ann Glob Health. 2019;85(1):8. https://doi.org/10.5334/aogh.2419 DOI: https://doi.org/10.5334/aogh.2419
16. Baldotto CS, Cronemberger EH, de Biasi P, Zamboni M, Sousa A, Zukin M, et al. Palliative care in poor-performance status small cell lung cancer patients: is there a mandatory role for chemotherapy? Support Care Cancer. 2012;20(11):2721-2727. https://doi.org/10.1007/s00520-012-1392-0 DOI: https://doi.org/10.1007/s00520-012-1392-0
17. Soares M, Antunes L, Redondo P, Borges M, Grimson F, Hermans R, et al. Small cell lung cancer treatment and survival in Portugal: a retrospective analysis from the I-O Optimise initiative. Eur J Cancer Care (Engl). 2021;30(6):e13496. https://doi.org/10.1111/ecc.13496 DOI: https://doi.org/10.1111/ecc.13496
18. Wang S, Tang J, Sun T, Zheng X, Li J, Sun H, et al. Survival changes in patients with small cell lung cancer and disparities between different sexes, socioeconomic statuses and ages. Sci Rep. 2017;7(1):1339. https://doi.org/10.1038/s41598-017-01571-0 DOI: https://doi.org/10.1038/s41598-017-01571-0
19. Evers J, Hendriks LEL, De Jaeger K, Wijsman R, De Ruysscher D, Terhaard C, et al. Trends and variations in the treatment of stage I-III small cell lung cancer from 2008 to 2019: a nationwide population-based study from the Netherlands. Lung Cancer. 2021;162:61-70. https://doi.org/10.1016/j.lungcan.2021.10.011 DOI: https://doi.org/10.1016/j.lungcan.2021.10.011
20. Franco F, Carcereny E, Guirado M, Ortega AL, López-Castro R, Rodríguez-Abreu D, et al. Epidemiology, treatment, and survival in small cell lung cancer in Spain: data from the Thoracic Tumor Registry. PLoS One. 2021;16(6):e0251761. https://doi.org/10.1371/journal.pone.0251761 DOI: https://doi.org/10.1371/journal.pone.0251761
21. World health Organization. Global Cancer Observatory. Cancer Today. https://gco.iarc.fr
22. World Health Organization. The Global Health Observatory. Estimate of current tobacco use prevalence. Distribution by country. https://www.who.int/data/gho/data/themes/topics/sdg-target-3_a-tobacco-control
23. Levy D, de Almeida LM, Szklo A. The Brazil SimSmoke policy simulation model: the effect of strong tobacco control policies on smoking prevalence and smoking-attributable deaths in a middle income nation. PLoS Med. 2012;9(11):e1001336. https://doi.org/10.1371/journal.pmed.1001336 DOI: https://doi.org/10.1371/journal.pmed.1001336
24. Sarma EA, Rendle KA, Kobrin SC. Cancer symptom awareness in the US: sociodemographic differences in a population-based survey of adults. Prev Med. 2020;132:106005. https://doi.org/10.1016/j.ypmed.2020.106005 DOI: https://doi.org/10.1016/j.ypmed.2020.106005
25. Araghi M, Fidler-Benaoudia M, Arnold M, Rutherford M, Bardot A, Ferlay J, et al. International differences in lung cancer survival by sex, histological type and stage at diagnosis: an ICBP SURVMARK-2 Study. Thorax. 2022;77(4):378-390. https://doi.org/10.1136/thoraxjnl-2020-216555 DOI: https://doi.org/10.1136/thoraxjnl-2020-216555
26. Oze I, Ito H, Nishino Y, Hattori M, Nakayama T, MiyashiroI, et al. Trends in small-cell lung cancer survival in 1993-2006 based on population-based cancer registry data in Japan. J Epidemiol. 2019;29(9):347-353. https://doi.org/10.2188/jea.JE20180112 DOI: https://doi.org/10.2188/jea.JE20180112
27. Tapan U, Furtado VF, Qureshi MM, Everett P, Suzuki K, Mak KS. Racial and other healthcare disparities in patients with extensive-stage SCLC. JTO Clin Res Rep. 2020;2(1):100109. https://doi.org/10.1016/j.jtocrr.2020.100109 DOI: https://doi.org/10.1016/j.jtocrr.2020.100109
28. Roof L, Wei W, Tullio K, Pennell NA, Stevenson JP. Impact of socioeconomic factors on overall survival in SCLC. JTO Clin Res Rep. 2022;3(7):100360. https://doi.org/10.1016/j.jtocrr.2022.100360 DOI: https://doi.org/10.1016/j.jtocrr.2022.100360
29. Massignam FM, Bastos JLD, Nedel FB. Discriminação e saúde: um problema de acesso. Epidemiol Serv Saúde. 2015;24(3):541-544. https://doi.org/10.5123/S1679-49742015000300020 DOI: https://doi.org/10.5123/S1679-49742015000300020
30. Jansen RJ, Alexander BH, Anderson KE, Church TR. Quantifying lead-time bias in risk factor studies of cancer through simulation. Ann Epidemiol. 2013;23(11):735-741. https://doi.org/10.1016/j.annepidem.2013.07.021
31. Kwak SK, Kim JH. Statistical data preparation: management of missing values and outliers. Korean J Anesthesiol. 2017;70(4):407-411. https://doi.org/10.4097/kjae.2017.70.4.407
32. Jansen RJ, Alexander BH, Anderson KE, Church TR. Quantifying lead-time bias in risk factor studies of cancer through simulation. Ann Epidemiol [Internet]. 2013 [cited 2025 Sep 26];23(11):735–41. Available from:] https://doi.org/10.1016/j.annepidem.2013.07.021. DOI: https://doi.org/10.1016/j.annepidem.2013.07.021
33. Kwak SK, Kim JH. Statistical data preparation: management of missing values and outliers. Korean J Anesthesiol [Internet]. 2017 [cited 2025 Sep 26];70(4):407–11. Available from: https://doi.org/10.4097/kjae.2017.70.4.407. DOI: https://doi.org/10.4097/kjae.2017.70.4.407
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Copyright (c) 2025 Gelcio Luiz Quintella Mendes, Luiz Henrique de Lima Araújo, Aureliano Mota Cavalcanti de Sousa, Debora Santos da Silva, Rafael Tavares Jomar
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