Small cell carcinoma of the lung natural history, complications and prognosis: Difference between revisions

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==Overview==
==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.<ref name="GreenHumphrey1969">{{cite journal|last1=Green|first1=Robert A.|last2=Humphrey|first2=Edward|last3=Close|first3=Henry|last4=Patno|first4=Mary Ellen|title=Alkylating agents in bronchogenic carcinoma|journal=The American Journal of Medicine|volume=46|issue=4|year=1969|pages=516–525|issn=00029343|doi=10.1016/0002-9343(69)90071-0}}</ref>
The [[Natural history of disease|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]]. 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. SCLC can be complicated by [[paraneoplastic syndrome]]s. Limited stage disease, absence of [[brain]] [[metastasis]], young age, and female sex are considered good [[prognostic]] factors.


==Natural History==
==Natural History, Complications, and Prognosis==
===Limited-Stage Disease===
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]]. 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 better [[prognosis]].


===Extensive-Stage Disease===
=== Natutral History ===
Patients with extensive-stage disease have [[tumors]] that have spread beyond the [[supraclavicular]] areas.  These patients 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. Long-term disease-free survival is rare.


==Complications==
* Approximately 30% of the [[Patient|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]].
===Complications of the Disease Itself===
* [[Patients]] with extensive-stage disease have [[tumors]] that have spread beyond the [[supraclavicular]] areas.<ref name="NCI">General Information About Small Cell Lung Cancer. National cancer institute. Accessed on June 17.[http://www.cancer.gov/cancertopics/pdq/treatment/small-cell-lung/healthprofessional/page1]</ref><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><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><ref name="GreenHumphrey1969">{{cite journal|last1=Green|first1=Robert A.|last2=Humphrey|first2=Edward|last3=Close|first3=Henry|last4=Patno|first4=Mary Ellen|title=Alkylating agents in bronchogenic carcinoma|journal=The American Journal of Medicine|volume=46|issue=4|year=1969|pages=516–525|issn=00029343|doi=10.1016/0002-9343(69)90071-0}}</ref>
* [[SIADH]]<ref name="pmid16813730">{{cite journal| author=Gandhi L, Johnson BE| title=Paraneoplastic syndromes associated with small cell lung cancer. | journal=J Natl Compr Canc Netw | year= 2006 | volume= 4 | issue= 6 | pages= 631-8 | pmid=16813730 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=16813730  }} </ref>
 
* [[Cushing syndrome]] (due to production of [[ACTH]])<ref name="pmid16813730">{{cite journal| author=Gandhi L, Johnson BE| title=Paraneoplastic syndromes associated with small cell lung cancer. | journal=J Natl Compr Canc Netw | year= 2006 | volume= 4 | issue= 6 | pages= 631-8 | pmid=16813730 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=16813730  }} </ref>
===Complications===
* [[Hypertension]] (due to production of [[renin]])<ref name="pmid16813730">{{cite journal| author=Gandhi L, Johnson BE| title=Paraneoplastic syndromes associated with small cell lung cancer. | journal=J Natl Compr Canc Netw | year= 2006 | volume= 4 | issue= 6 | pages= 631-8 | pmid=16813730 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=16813730  }} </ref>
=====Complications of the Disease Itself=====
* [[Amenorrhea]]  (due to production of [[prolactin]] or [[growth hormone]])<ref name="pmid16813730">{{cite journal| author=Gandhi L, Johnson BE| title=Paraneoplastic syndromes associated with small cell lung cancer. | journal=J Natl Compr Canc Netw | year= 2006 | volume= 4 | issue= 6 | pages= 631-8 | pmid=16813730 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=16813730  }} </ref>
 
* [[Galactorrhea]]  (due to production of [[prolactin]] or [[growth hormone]])<ref name="pmid16813730">{{cite journal| author=Gandhi L, Johnson BE| title=Paraneoplastic syndromes associated with small cell lung cancer. | journal=J Natl Compr Canc Netw | year= 2006 | volume= 4 | issue= 6 | pages= 631-8 | pmid=16813730 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=16813730  }} </ref>
*[[SIADH]]<ref name="pmid16813730">{{cite journal| author=Gandhi L, Johnson BE| title=Paraneoplastic syndromes associated with small cell lung cancer. | journal=J Natl Compr Canc Netw | year= 2006 | volume= 4 | issue= 6 | pages= 631-8 | pmid=16813730 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=16813730  }} </ref>
* Increased production of amylase<ref name="pmid16813730">{{cite journal| author=Gandhi L, Johnson BE| title=Paraneoplastic syndromes associated with small cell lung cancer. | journal=J Natl Compr Canc Netw | year= 2006 | volume= 4 | issue= 6 | pages= 631-8 | pmid=16813730 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=16813730  }} </ref>
*[[Cushing syndrome]] (due to production of [[ACTH]])<ref name="pmid16813730">{{cite journal| author=Gandhi L, Johnson BE| title=Paraneoplastic syndromes associated with small cell lung cancer. | journal=J Natl Compr Canc Netw | year= 2006 | volume= 4 | issue= 6 | pages= 631-8 | pmid=16813730 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=16813730  }} </ref>
* Excessive [[parathormone]] (PTH) secretion<ref name="pmid17918299">{{cite journal| author=Radulescu D, Pripon S, Bunea D, Ciuleanu TE, Radulescu LI| title=Endocrine paraneoplastic syndromes in small cell lung carcinoma. Two case reports. | journal=J BUON | year= 2007 | volume= 12 | issue= 3 | pages= 411-4 | pmid=17918299 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=17918299  }} </ref>
*[[Hypertension]] (due to production of [[renin]])<ref name="pmid16813730">{{cite journal| author=Gandhi L, Johnson BE| title=Paraneoplastic syndromes associated with small cell lung cancer. | journal=J Natl Compr Canc Netw | year= 2006 | volume= 4 | issue= 6 | pages= 631-8 | pmid=16813730 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=16813730  }} </ref>
* [[Lambert-Eaton myasthenic syndrome]] (LEMS)<ref name="pmid1659614">{{cite journal| author=Elrington GM, Murray NM, Spiro SG, Newsom-Davis J| title=Neurological paraneoplastic syndromes in patients with small cell lung cancer. A prospective survey of 150 patients. | journal=J Neurol Neurosurg Psychiatry | year= 1991 | volume= 54 | issue= 9 | pages= 764-7 | pmid=1659614 | doi= | pmc=PMC1014512 | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=1659614  }} </ref>
*[[Amenorrhea]]  (due to production of [[prolactin]] or [[growth hormone]])<ref name="pmid16813730">{{cite journal| author=Gandhi L, Johnson BE| title=Paraneoplastic syndromes associated with small cell lung cancer. | journal=J Natl Compr Canc Netw | year= 2006 | volume= 4 | issue= 6 | pages= 631-8 | pmid=16813730 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=16813730  }} </ref>
*[[Galactorrhea]]  (due to production of [[prolactin]] or [[growth hormone]])<ref name="pmid16813730">{{cite journal| author=Gandhi L, Johnson BE| title=Paraneoplastic syndromes associated with small cell lung cancer. | journal=J Natl Compr Canc Netw | year= 2006 | volume= 4 | issue= 6 | pages= 631-8 | pmid=16813730 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=16813730  }} </ref>
* Increased production of [[amylase]]<ref name="pmid16813730">{{cite journal| author=Gandhi L, Johnson BE| title=Paraneoplastic syndromes associated with small cell lung cancer. | journal=J Natl Compr Canc Netw | year= 2006 | volume= 4 | issue= 6 | pages= 631-8 | pmid=16813730 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=16813730  }} </ref>
* Excessive [[parathormone]] ([[Parathyroid hormone|PTH]]) secretion<ref name="pmid17918299">{{cite journal| author=Radulescu D, Pripon S, Bunea D, Ciuleanu TE, Radulescu LI| title=Endocrine paraneoplastic syndromes in small cell lung carcinoma. Two case reports. | journal=J BUON | year= 2007 | volume= 12 | issue= 3 | pages= 411-4 | pmid=17918299 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=17918299  }} </ref>
*[[Lambert-Eaton myasthenic syndrome]] (LEMS)<ref name="pmid1659614">{{cite journal| author=Elrington GM, Murray NM, Spiro SG, Newsom-Davis J| title=Neurological paraneoplastic syndromes in patients with small cell lung cancer. A prospective survey of 150 patients. | journal=J Neurol Neurosurg Psychiatry | year= 1991 | volume= 54 | issue= 9 | pages= 764-7 | pmid=1659614 | doi= | pmc=PMC1014512 | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=1659614  }} </ref>
* Subacute [[sensory neuropathy]]<ref name="pmid1659614">{{cite journal| author=Elrington GM, Murray NM, Spiro SG, Newsom-Davis J| title=Neurological paraneoplastic syndromes in patients with small cell lung cancer. A prospective survey of 150 patients. | journal=J Neurol Neurosurg Psychiatry | year= 1991 | volume= 54 | issue= 9 | pages= 764-7 | pmid=1659614 | doi= | pmc=PMC1014512 | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=1659614  }} </ref>
* Subacute [[sensory neuropathy]]<ref name="pmid1659614">{{cite journal| author=Elrington GM, Murray NM, Spiro SG, Newsom-Davis J| title=Neurological paraneoplastic syndromes in patients with small cell lung cancer. A prospective survey of 150 patients. | journal=J Neurol Neurosurg Psychiatry | year= 1991 | volume= 54 | issue= 9 | pages= 764-7 | pmid=1659614 | doi= | pmc=PMC1014512 | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=1659614  }} </ref>
* Paraneoplastic limbic encephalopathy<ref name="pmid1329233">{{cite journal| author=Amir J, Galbraith RC| title=Paraneoplastic limbic encephalopathy as a nonmetastatic complication of small cell lung cancer. | journal=South Med J | year= 1992 | volume= 85 | issue= 10 | pages= 1013-4 | pmid=1329233 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=1329233  }} </ref>
*[[Paraneoplastic syndrome|Paraneoplastic]] [[Limbic encephalitis|limbic]] [[encephalopathy]]<ref name="pmid1329233">{{cite journal| author=Amir J, Galbraith RC| title=Paraneoplastic limbic encephalopathy as a nonmetastatic complication of small cell lung cancer. | journal=South Med J | year= 1992 | volume= 85 | issue= 10 | pages= 1013-4 | pmid=1329233 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=1329233  }} </ref>
* [[Encephalomyelitis]]<ref name="pmid1329233">{{cite journal| author=Amir J, Galbraith RC| title=Paraneoplastic limbic encephalopathy as a nonmetastatic complication of small cell lung cancer. | journal=South Med J | year= 1992 | volume= 85 | issue= 10 | pages= 1013-4 | pmid=1329233 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=1329233  }} </ref>
*[[Encephalomyelitis]]<ref name="pmid1329233">{{cite journal| author=Amir J, Galbraith RC| title=Paraneoplastic limbic encephalopathy as a nonmetastatic complication of small cell lung cancer. | journal=South Med J | year= 1992 | volume= 85 | issue= 10 | pages= 1013-4 | pmid=1329233 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=1329233  }} </ref>
* [[Paraneoplastic cerebellar degeneration]]<ref name="pmid1329233">{{cite journal| author=Amir J, Galbraith RC| title=Paraneoplastic limbic encephalopathy as a nonmetastatic complication of small cell lung cancer. | journal=South Med J | year= 1992 | volume= 85 | issue= 10 | pages= 1013-4 | pmid=1329233 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=1329233  }} </ref>
*[[Paraneoplastic cerebellar degeneration]]<ref name="pmid1329233">{{cite journal| author=Amir J, Galbraith RC| title=Paraneoplastic limbic encephalopathy as a nonmetastatic complication of small cell lung cancer. | journal=South Med J | year= 1992 | volume= 85 | issue= 10 | pages= 1013-4 | pmid=1329233 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=1329233  }} </ref>
* [[Retinopathy]]<ref name="pmid1329233">{{cite journal| author=Amir J, Galbraith RC| title=Paraneoplastic limbic encephalopathy as a nonmetastatic complication of small cell lung cancer. | journal=South Med J | year= 1992 | volume= 85 | issue= 10 | pages= 1013-4 | pmid=1329233 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=1329233  }} </ref>
*[[Retinopathy]]<ref name="pmid1329233">{{cite journal| author=Amir J, Galbraith RC| title=Paraneoplastic limbic encephalopathy as a nonmetastatic complication of small cell lung cancer. | journal=South Med J | year= 1992 | volume= 85 | issue= 10 | pages= 1013-4 | pmid=1329233 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=1329233  }} </ref>
* [[Myoclonus]]<ref name="pmid1329233">{{cite journal| author=Amir J, Galbraith RC| title=Paraneoplastic limbic encephalopathy as a nonmetastatic complication of small cell lung cancer. | journal=South Med J | year= 1992 | volume= 85 | issue= 10 | pages= 1013-4 | pmid=1329233 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=1329233  }} </ref>
*[[Myoclonus]]<ref name="pmid1329233">{{cite journal| author=Amir J, Galbraith RC| title=Paraneoplastic limbic encephalopathy as a nonmetastatic complication of small cell lung cancer. | journal=South Med J | year= 1992 | volume= 85 | issue= 10 | pages= 1013-4 | pmid=1329233 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=1329233 }} </ref>
*[[Tripe palms]]<ref name="pmid8638207">{{cite journal| author=Mullans EA, Cohen PR| title=Tripe palms: a cutaneous paraneoplastic syndrome. | journal=South Med J | year= 1996 | volume= 89 | issue= 6 | pages= 626-7 | pmid=8638207 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=8638207 }} </ref>


===Complications of the Treatment===
=====Complications of the Treatment=====
Post operative complications following surgery include:<ref name="pmid11120906">{{cite journal| author=Uramoto H, Nakanishi R, Fujino Y, Imoto H, Takenoyama M, Yoshimatsu T et al.| title=Prediction of pulmonary complications after a lobectomy in patients with non-small cell lung cancer. | journal=Thorax | year= 2001 | volume= 56 | issue= 1 | pages= 59-61 | pmid=11120906 | doi= | pmc=PMC1745907 | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=11120906  }} </ref>
Post operative complications following surgery include:<ref name="pmid11120906">{{cite journal| author=Uramoto H, Nakanishi R, Fujino Y, Imoto H, Takenoyama M, Yoshimatsu T et al.| title=Prediction of pulmonary complications after a lobectomy in patients with non-small cell lung cancer. | journal=Thorax | year= 2001 | volume= 56 | issue= 1 | pages= 59-61 | pmid=11120906 | doi= | pmc=PMC1745907 | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=11120906  }} </ref>
* [[Atelectasis]]
* [[Atelectasis]]
* [[Pneumonia]]
* [[Pneumonia]]
* [[Arrhythmia]]
* [[Arrhythmia]]
* Wound infection
* [[Wound]] infection
* [[Colitis]]
* [[Colitis]]
* Liver dysfuntion
* [[Liver]] dysfuntion
* [[Gastric ulcer]]
* [[Gastric ulcer]]


==Prognosis==
===Prognosis===
===Prognostic Factors===
====Good 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.
 
*[[Small cell carcinoma of the lung staging|Limited stage disease]]<ref name="NCI">General Information About Small Cell Lung Cancer. National cancer institute. Accessed on June 17.[http://www.cancer.gov/cancertopics/pdq/treatment/small-cell-lung/healthprofessional/page1]</ref>
* Absence of brain [[metastasis]]<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>
* Young age<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>
* Female sex<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>
* Asian ethnicity<ref name="pmid19096304">{{cite journal| author=Ou SH, Ziogas A, Zell JA| title=Prognostic factors for survival in extensive stage small cell lung cancer (ED-SCLC): the importance of smoking history, socioeconomic and marital statuses, and ethnicity. | journal=J Thorac Oncol | year= 2009 | volume= 4 | issue= 1 | pages= 37-43 | pmid=19096304 | doi=10.1097/JTO.0b013e31819140fb | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=19096304  }} </ref>
* Normal [[white blood cell count]]<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>
* Surgical resection, [[radiotherapy|radiation]], and [[chemotherapy]]<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><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>
 
====Bad Prognostic Factors====


*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.<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>
*[[Small cell carcinoma of the lung staging|Extensive stage disease]]<ref name="NCI">General Information About Small Cell Lung Cancer. National cancer institute. Accessed on June 17.[http://www.cancer.gov/cancertopics/pdq/treatment/small-cell-lung/healthprofessional/page1]</ref>
*Age: Advanced age and young age at the time of diagnosis are considered as negative and favorable prognostic factors of the disease respectively.<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>  
*[[Lung cancer staging|TNM stage III]]<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>
*Sex: While diseased males are associated with a worse survival, diseased females live significantly longer than diseased males.<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>
* Advanced age<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>
*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.<ref name="pmid19096304">{{cite journal| author=Ou SH, Ziogas A, Zell JA| title=Prognostic factors for survival in extensive stage small cell lung cancer (ED-SCLC): the importance of smoking history, socioeconomic and marital statuses, and ethnicity. | journal=J Thorac Oncol | year= 2009 | volume= 4 | issue= 1 | pages= 37-43 | pmid=19096304 | doi=10.1097/JTO.0b013e31819140fb | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=19096304  }} </ref>  
* Male sex<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>
*Ethnicity: Hispanics and African Americas are significantly affected and they carry a poor prognosis.  But Asian ethnicity carry a favorable prognosis.<ref name="pmid19096304">{{cite journal| author=Ou SH, Ziogas A, Zell JA| title=Prognostic factors for survival in extensive stage small cell lung cancer (ED-SCLC): the importance of smoking history, socioeconomic and marital statuses, and ethnicity. | journal=J Thorac Oncol | year= 2009 | volume= 4 | issue= 1 | pages= 37-43 | pmid=19096304 | doi=10.1097/JTO.0b013e31819140fb | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=19096304  }} </ref>    
* Lower socioeconomic status<ref name="pmid19096304">{{cite journal| author=Ou SH, Ziogas A, Zell JA| title=Prognostic factors for survival in extensive stage small cell lung cancer (ED-SCLC): the importance of smoking history, socioeconomic and marital statuses, and ethnicity. | journal=J Thorac Oncol | year= 2009 | volume= 4 | issue= 1 | pages= 37-43 | pmid=19096304 | doi=10.1097/JTO.0b013e31819140fb | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=19096304  }}</ref>
*Performance status: Poor performance status is significantly associated with a reduced duration of 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>
* Hispanic and African American ethnicity<ref name="pmid19096304">{{cite journal| author=Ou SH, Ziogas A, Zell JA| title=Prognostic factors for survival in extensive stage small cell lung cancer (ED-SCLC): the importance of smoking history, socioeconomic and marital statuses, and ethnicity. | journal=J Thorac Oncol | year= 2009 | volume= 4 | issue= 1 | pages= 37-43 | pmid=19096304 | doi=10.1097/JTO.0b013e31819140fb | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=19096304  }}</ref>
*Smoking: A positive smoking history is a well known and established independent poor prognostic factor for small cell carcinoma of the lung.
* Poor [[performance status]]<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>
*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>
*[[Smoking]]
*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>
* Reduced [[hemoglobin]] and raised serum [[lactate dehydrogenase]]<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===
===5-Year Survival===
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* 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>
* 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>
* 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>
* 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>
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{| style="cellpadding=0; cellspacing= 0; width: 600px;"
{| 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="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: #DCDCDC" align="center" |'''All stages'''
| style="font-size: 100; padding: 0 5px; background: #F5F5F5" align="center" |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: #DCDCDC" align="center" |'''Localized'''
| style="font-size: 100; padding: 0 5px; background: #F5F5F5" align="center" |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: #DCDCDC" align="center" |'''Regional'''|| style="font-size: 100; padding: 0 5px; background: #F5F5F5" align="center" |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: #DCDCDC" align="center" |'''Distant'''|| style="font-size: 100; padding: 0 5px; background: #F5F5F5" align="center" |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%
| style="font-size: 100; padding: 0 5px; background: #DCDCDC" align="center" |'''Unstaged'''|| style="font-size: 100; padding: 0 5px; background: #F5F5F5" align="center" |7.8%
|}
|}


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[[Category:Pulmonology]]
[[Category:Pulmonology]]
[[Category:Lung cancer]]
[[Category:Lung cancer]]
[[Category:Oncology]]


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Latest revision as of 22:19, 3 September 2019

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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. 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. SCLC can be complicated by paraneoplastic syndromes. Limited stage disease, absence of brain metastasis, young age, and female sex are considered good prognostic factors.

Natural History, Complications, and Prognosis

Natutral History

Complications

Complications of the Disease Itself
Complications of the Treatment

Post operative complications following surgery include:[10]

Prognosis

Good Prognostic Factors

Bad Prognostic Factors

5-Year Survival

  • Between 2004 and 2010, the 5-year relative survival of patients with SCLC was 6.6%.[13]
  • 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.[13]
  • 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:[13]
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. ↑ 1.0 1.1 1.2 General Information About Small Cell Lung Cancer. National cancer institute. Accessed on June 17.[1]
  2. ↑ 2.0 2.1 2.2 2.3 2.4 2.5 2.6 2.7 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.
  3. ↑ 3.0 3.1 3.2 3.3 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.
  4. ↑ 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.
  5. ↑ 5.0 5.1 5.2 5.3 5.4 5.5 Gandhi L, Johnson BE (2006). "Paraneoplastic syndromes associated with small cell lung cancer". J Natl Compr Canc Netw. 4 (6): 631–8. PMID 16813730.
  6. ↑ 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.
  7. ↑ 7.0 7.1 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.
  8. ↑ 8.0 8.1 8.2 8.3 8.4 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.
  9. ↑ Mullans EA, Cohen PR (1996). "Tripe palms: a cutaneous paraneoplastic syndrome". South Med J. 89 (6): 626–7. PMID 8638207.
  10. ↑ 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.
  11. ↑ 11.0 11.1 11.2 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.
  12. ↑ 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.
  13. ↑ 13.0 13.1 13.2 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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