Small cell carcinoma of the lung natural history, complications and prognosis: Difference between revisions
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*Laboratory values: [[Albumin]] is another 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.<ref name="pmid3015384">{{cite journal| author=Osterlind K, Andersen PK| title=Prognostic factors in small cell lung cancer: multivariate model based on 778 patients treated with chemotherapy with or without irradiation. | journal=Cancer Res | year= 1986 | volume= 46 | issue= 8 | pages= 4189-94 | pmid=3015384 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=3015384 }} </ref> A normal white blood cell count is the most powerful positive prognostic indicator among laboratory values.<ref name="pmid17214347">{{cite journal| author=Brueckl WM, Herbst L, Lechler A, Fuchs F, Schoeberl A, Zirlik S et al.| title=Predictive and prognostic factors in small cell lung carcinoma (SCLC)--analysis from routine clinical practice. | journal=Anticancer Res | year= 2006 | volume= 26 | issue= 6C | pages= 4825-32 | pmid=17214347 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=17214347 }} </ref> | *Laboratory values: [[Albumin]] is another 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.<ref name="pmid3015384">{{cite journal| author=Osterlind K, Andersen PK| title=Prognostic factors in small cell lung cancer: multivariate model based on 778 patients treated with chemotherapy with or without irradiation. | journal=Cancer Res | year= 1986 | volume= 46 | issue= 8 | pages= 4189-94 | pmid=3015384 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=3015384 }} </ref> A normal white blood cell count is the most powerful positive prognostic indicator among laboratory values.<ref name="pmid17214347">{{cite journal| author=Brueckl WM, Herbst L, Lechler A, Fuchs F, Schoeberl A, Zirlik S et al.| title=Predictive and prognostic factors in small cell lung carcinoma (SCLC)--analysis from routine clinical practice. | journal=Anticancer Res | year= 2006 | volume= 26 | issue= 6C | pages= 4825-32 | pmid=17214347 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=17214347 }} </ref> | ||
*Treatment: All treatment modalities like surgical resection,<ref name="pmid22000695">{{cite journal| author=Gaspar LE, McNamara EJ, Gay EG, Putnam JB, Crawford J, Herbst RS et al.| title=Small-cell lung cancer: prognostic factors and changing treatment over 15 years. | journal=Clin Lung Cancer | year= 2012 | volume= 13 | issue= 2 | pages= 115-22 | pmid=22000695 | doi=10.1016/j.cllc.2011.05.008 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=22000695 }} </ref> radiation, and chemotherapy serve as favorable prognostic factors, contributing to the survival.<ref name="pmid3015384">{{cite journal| author=Osterlind K, Andersen PK| title=Prognostic factors in small cell lung cancer: multivariate model based on 778 patients treated with chemotherapy with or without irradiation. | journal=Cancer Res | year= 1986 | volume= 46 | issue= 8 | pages= 4189-94 | pmid=3015384 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=3015384 }} </ref> | *Treatment: All treatment modalities like surgical resection,<ref name="pmid22000695">{{cite journal| author=Gaspar LE, McNamara EJ, Gay EG, Putnam JB, Crawford J, Herbst RS et al.| title=Small-cell lung cancer: prognostic factors and changing treatment over 15 years. | journal=Clin Lung Cancer | year= 2012 | volume= 13 | issue= 2 | pages= 115-22 | pmid=22000695 | doi=10.1016/j.cllc.2011.05.008 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=22000695 }} </ref> radiation, and chemotherapy serve as favorable prognostic factors, contributing to the survival.<ref name="pmid3015384">{{cite journal| author=Osterlind K, Andersen PK| title=Prognostic factors in small cell lung cancer: multivariate model based on 778 patients treated with chemotherapy with or without irradiation. | journal=Cancer Res | year= 1986 | volume= 46 | issue= 8 | pages= 4189-94 | pmid=3015384 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=3015384 }} </ref> | ||
===5-Year Survival=== | |||
* Between 2004 and 2010, the 5-year relative survival of patients with SCLC was 6.6%.<ref name="SEER">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.</ref> | |||
* 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.<ref name="SEER">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.</ref> | |||
* 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:<ref name="SEER">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.</ref> | |||
{| style="cellpadding=0; cellspacing= 0; width: 600px;" | |||
|- | |||
|style="padding: 0 5px; font-size: 100%; background: #4682B4; color: #FFFFFF; width: 10%" align=center |'''Stage'''|| style="padding: 0 5px; font-size: 100%; background: #4682B4; color: #FFFFFF; width: 10%" align=center | '''5-year relative survival (%), (2004-2010)''' | |||
|- | |||
| style="font-size: 100; padding: 0 5px; background: #B8B8B8" align=left |'''All stages'''|| style="font-size: 100; padding: 0 5px; background: #B8B8B8" align=left |6.3% | |||
|- | |||
| style="font-size: 100; padding: 0 5px; background: #B8B8B8" align=left |'''Localized'''|| style="font-size: 100; padding: 0 5px; background: #B8B8B8" align=left |24.2% | |||
|- | |||
| style="font-size: 100; padding: 0 5px; background: #B8B8B8" align=left |'''Regional'''|| style="font-size: 100; padding: 0 5px; background: #B8B8B8" align=left |14.3% | |||
|- | |||
| style="font-size: 100; padding: 0 5px; background: #B8B8B8" align=left |'''Distant'''|| style="font-size: 100; padding: 0 5px; background: #B8B8B8" align=left |2.8% | |||
|- | |||
| style="font-size: 100; padding: 0 5px; background: #B8B8B8" align=left |'''Unstaged'''|| style="font-size: 100; padding: 0 5px; background: #B8B8B8" align=left |7.8% | |||
|} | |||
==References== | ==References== |
Revision as of 19:57, 17 June 2014
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Vendhan Ramanujam M.B.B.S [2]
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]
Natural History
Limited-Stage Disease
At the time of diagnosis, approximately 30% of patients with SCLC will have tumor confined to the hemithorax of origin, the mediastinum, or the supraclavicular lymph nodes. These patients are designated as having limited-stage disease, and most 2-year disease-free survivors come from this group. In limited-stage disease, median survival of 16 to 24 months with current forms of treatment can reasonably be expected. A small proportion of patients with limited-stage disease may benefit from surgery with or without adjuvant chemotherapy; these patients have an even better prognosis.
Extensive-Stage Disease
Patients with tumors that have spread beyond the supraclavicular areas are said to have extensive-stage disease and have a worse prognosis than patients with limited-stage disease. Median survival of 6 to 12 months is reported with currently available therapy, but long-term disease-free survival is rare.
Complications
Complications of the Disease Itself
- SIADH[2]
- Cushing syndrome (due to production of ACTH)[2]
- Hypertension (due to production of renin)[2]
- Amenorrhea (due to production of prolactin or growth hormone)[2]
- Galactorrhea (due to production of prolactin or growth hormone)[2]
- Increased production of amylase[2]
- Excessive parathormone (PTH) secretion[3]
- Lambert-Eaton myasthenic syndrome (LEMS)[4]
- Subacute sensory neuropathy[4]
- Paraneoplastic limbic encephalopathy[5]
- Encephalomyelitis[5]
- Paraneoplastic cerebellar degeneration[5]
- Retinopathy[5]
- Myoclonus[5]
Complications of the Treatment
Post operative complications following surgery include:[6]
- Atelectasis
- Pneumonia
- Arrhythmia
- Wound infection
- Colitis
- Liver dysfuntion
- Gastric ulcer
Prognosis
Prognostic Factors
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.
- 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. But absence of metastasIs in the brain at the time of diagnosis and limited stage disease may be positive prognostic indicators.[7]
- Age: Advanced age and young age at the time of diagnosis are considered as negative and favorable prognostic factors of the disease respectively.[8]
- Sex: While diseased males are associated with a worse survival, diseased females live significantly longer than diseased males.[8]
- 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.[9]
- Ethnicity: Hispanics and African Americas are significantly affected and they carry a poor prognosis. But Asian ethnicity carry a favorable prognosis.[9]
- Performance status: Poor performance status is significantly associated with a reduced duration of survival.[8]
- 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 another 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.[8] A normal white blood cell count is the most powerful positive prognostic indicator among laboratory values.[7]
- Treatment: All treatment modalities like surgical resection,[10] radiation, and chemotherapy serve as favorable prognostic factors, contributing to the survival.[8]
5-Year Survival
- Between 2004 and 2010, the 5-year relative survival of patients with SCLC was 6.6%.[11]
- 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.[11]
- 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:[11]
Stage | 5-year relative survival (%), (2004-2010) |
All stages | 6.3% |
Localized | 24.2% |
Regional | 14.3% |
Distant | 2.8% |
Unstaged | 7.8% |
References
- ↑ 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.
- ↑ 2.0 2.1 2.2 2.3 2.4 2.5 Gandhi L, Johnson BE (2006). "Paraneoplastic syndromes associated with small cell lung cancer". J Natl Compr Canc Netw. 4 (6): 631–8. PMID 16813730.
- ↑ 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.
- ↑ 4.0 4.1 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.
- ↑ 5.0 5.1 5.2 5.3 5.4 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.
- ↑ 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.
- ↑ 7.0 7.1 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.
- ↑ 8.0 8.1 8.2 8.3 8.4 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.
- ↑ 9.0 9.1 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.
- ↑ 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.
- ↑ 11.0 11.1 11.2 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.