TY - JOUR
T1 - Trends in the outcomes for patients with limited stage small cell lung cancer
T2 - An analysis of the Surveillance, Epidemiology, and End Results database
AU - Lally, Brian E.
AU - Geiger, Ann M.
AU - Urbanic, James J.
AU - Butler, Jerome M.
AU - Wentworth, Stacy
AU - Perry, Michael C.
AU - Wilson, Lynn D.
AU - Horton, Janet K.
AU - Detterbeck, Frank C.
AU - Miller, Antonius A.
AU - Thomas, Charles R.
AU - Blackstock, A. William
N1 - Funding Information:
Special thanks to Dr. Carolyn Ferree for her critical review of the manuscript and Dr. Feng-Ming (Spring) Phoenix Kong for her assistance in learning of current patterns of care. Brian E. Lally was supported by NIH grant T32CA113267, TRADONC fellowship.
PY - 2009/5
Y1 - 2009/5
N2 - We used the Surveillance, Epidemiology, and End Results (SEER) database to examine the outcomes of patients with limited stage small cell lung cancer (LS-SCLC) over time and to determine if any trends were present with respect to the publication of significant clinical trials. We assembled a cohort of 6271 patients aged 21 years and older with LS-SCLC diagnosed from 1983 to 1998 and followed through 2005. Potential covariates included patient age at diagnosis, sex, race, year of diagnosis, laterality, tumor size, and location (upper lobe, middle lobe, lower lobe, or main bronchus). In multivariate analysis, older age, male sex, African American race, and main bronchus location were all associated with a statistically significant increase in the mortality hazard. When compared to patients diagnosed in 1983-1987 who did not receive radiotherapy, the hazard for mortality was significantly reduced for patients diagnosed in 1988-1992 regardless of whether they received radiotherapy (HR = 0.59; CI 0.52-0.65; p < 0.0001) or not (HR = 0.67; CI 0.60-0.75; p < 0.0001). Patients who were diagnosed in 1993-1998 and received radiotherapy had similarly improved survival (HR = 0.53; CI 0.47-0.58; p < 0.0001), which was better than patients from the same time era who did not receive radiotherapy (HR = 0.77; CI 0.69-0.85; p < 0.0001). In conclusion, the survival for patients with LS-SCLC has improved over time. Many factors are likely involved, however we believe that part of this improvement was the result of clinical trials which investigated and subsequently defined chemoradiotherapy as the standard of care. In order to continue to improve clinical outcomes, clinical trials investigating new treatment paradigms are needed.
AB - We used the Surveillance, Epidemiology, and End Results (SEER) database to examine the outcomes of patients with limited stage small cell lung cancer (LS-SCLC) over time and to determine if any trends were present with respect to the publication of significant clinical trials. We assembled a cohort of 6271 patients aged 21 years and older with LS-SCLC diagnosed from 1983 to 1998 and followed through 2005. Potential covariates included patient age at diagnosis, sex, race, year of diagnosis, laterality, tumor size, and location (upper lobe, middle lobe, lower lobe, or main bronchus). In multivariate analysis, older age, male sex, African American race, and main bronchus location were all associated with a statistically significant increase in the mortality hazard. When compared to patients diagnosed in 1983-1987 who did not receive radiotherapy, the hazard for mortality was significantly reduced for patients diagnosed in 1988-1992 regardless of whether they received radiotherapy (HR = 0.59; CI 0.52-0.65; p < 0.0001) or not (HR = 0.67; CI 0.60-0.75; p < 0.0001). Patients who were diagnosed in 1993-1998 and received radiotherapy had similarly improved survival (HR = 0.53; CI 0.47-0.58; p < 0.0001), which was better than patients from the same time era who did not receive radiotherapy (HR = 0.77; CI 0.69-0.85; p < 0.0001). In conclusion, the survival for patients with LS-SCLC has improved over time. Many factors are likely involved, however we believe that part of this improvement was the result of clinical trials which investigated and subsequently defined chemoradiotherapy as the standard of care. In order to continue to improve clinical outcomes, clinical trials investigating new treatment paradigms are needed.
KW - Clinical trials
KW - Elderly
KW - Radiotherapy
KW - SEER
KW - Small cell lung cancer
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U2 - 10.1016/j.lungcan.2008.08.010
DO - 10.1016/j.lungcan.2008.08.010
M3 - Article
C2 - 18835059
AN - SCOPUS:63049093349
SN - 0169-5002
VL - 64
SP - 226
EP - 231
JO - Lung Cancer
JF - Lung Cancer
IS - 2
ER -