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Prognostic role of patient gender in limited-disease small-cell lung cancer treated with chemoradiotherapy

Geschlecht als prognostischer Faktor beim kleinzelligen Lungenkarzinom im Stadium „limited disease“ behandelt mit Radiochemotherapie

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Abstract

Background

Previous studies have demonstrated that female gender could be a prognostic factor in limited-disease (LD) small-cell lung cancer (SCLC), but the correlation between patient gender and survival parameters remains unclear.

Patients and methods

Data from 179 LD SCLC patients treated with definitive chemoradiotherapy (CRT) were reviewed. Influence of patient gender on time to progression (TTP), local control (LC), brain metastasis-free (BMFS), distant metastasis-free (DMFS) and overall survival (OS) was analysed.

Results

Definitive CRT was completed by 179 (110 men/69 women) patients. Of these, 68 (38%; 34 men/34 women) patients were treated in concurrent and 111 (62%; 76 men/35 women) in sequential mode. Prophylactic cranial irradiation (PCI) was subsequently applied in 70 (39%; 36 men/34 women) patients with partial or complete response after CRT. Median OS was 20 (95% confidence interval [CI] 10–22) and 14 (95% CI 10–18) months in female and male patients, respectively (p = 0.021). In subgroups defined by remission status (complete and partial response) after CRT, an OS benefit for females compared to males was also detected. There was no correlation between patient gender and TTP, LC or DMFS, and no difference in OS in the female and male subgroups treated with PCI. The incidence of metachronous brain metastases (BMs) in the male and female subgroups differed significantly (40/110 men vs. 18/69 women, p = 0.03). Also, mean BMFS was significantly longer in women (p = 0.023). Patient gender also significantly correlated with OS on multivariate analysis after adjustment for other prognostic factors (p = 0.04, HR 1.38, 95% CI 1.08–1.92).

Conclusion

In this heterogeneous LD SCLC patient cohort treated with definitive CRT, female gender was significantly associated with longer BMFS and OS, as well as with a lower incidence of metachronous brain failure.

Zusammenfassung

Hintergrund

Studien haben gezeigt, dass weibliches Geschlecht ein prognostischer Faktor beim kleinzelligen Lungenkarzinom (SCLC) im Stadium „limited disease“ (LD) sein könnte. Eine Korrelation zwischen Geschlecht und weiteren Überlebensparametern ist weiterhin unklar.

Patienten und Methoden

Behandlungsdaten von 179 LD-SCLC-Patienten mit definitiver Radiochemotherapie (CRT) wurden retrospektiv analysiert. Der Einfluss des Patientengeschlechts auf die Zeit bis zur Krankheitsprogression (TTP), lokale Kontrolle (LC), hirnmetastasenfreies (BMFS), fernmetastasenfreies (DMFS) und Gesamtüberleben (OS) wurden untersucht.

Ergebnisse

Eine CRT beendeten 179 Patienten (110 Männer/69 Frauen) erfolgreich. Die CRT erfolgte bei 68 Patienten simultan (38%; 34 Männern/34 Frauen), bei 111 Patienten sequentiell (62%; 76 Männern/35 Frauen). Eine anschließende prophylaktische Ganzhirnbestrahlung (PCI) erhielten 70 Patienten (39%; 36 Männern/34 Frauen) mit kompletter oder partieller Remission nach CRT. Das mediane OS betrug je 20 (95%-Konfidenzintervall [KI] 10–22) und 14 (95%-KI 10–18) Monate bei weiblichen und männlichen Patienten (p = 0,021). Subgruppenanalysen, definiert nach dem erreichten Remissionsstatus (komplett und partiell), ergaben einen Überlebensvorteil für Frauen gegenüber Männern. Es bestand keine Korrelation zwischen Geschlecht und TTP, LC und DMFS und kein Unterschied im OS zwischen Männern und Frauen mit PCI. Die Inzidenz für metachrone Hirnmetastasen unterschied sich zwischen den Geschlechtern signifikant (40/110 Männern vs. 18/69 Frauen; p = 0,03). Das BMFS war jedoch signifikant länger bei Frauen (p = 0,023). Geschlecht und OS korrelierten auch in der multivariaten Analyse signifikant (p = 0,04; HR 1,38; 95%-KI 1,08–1,92).

Schlussfolgerung

In dieser heterogenen Kohorte von LD-SCLC-Patienten, behandelt mit definitiver CRT, korreliert weibliches Geschlecht signifikant mit längerem OS und BMFS sowie mit geringer Inzidenz für metachrone Hirnmetastasierung.

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Abbreviations

BM:

Brain metastasis

CRT:

Chemoradiotherapy

CT:

Computed tomography

DMFS:

Distant metastasis-free survival

LD:

Limited disease

OS:

Overall survival

PCI:

Prophylactic cranial irradiation

PS:

Performance status

SCLC:

Small-cell lung cancer

TRT:

Thoracic radiation therapy

TTP:

Time to progression

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Authors and Affiliations

  1. Department of Radiation Oncology, LMU Munich, Marchioninistraße 15, 81377, Munich, Germany

    Olarn Roengvoraphoj MD, Chukwuka Eze MD, Maximilian Niyazi MD, PhD, Minglun Li MD, Claus Belka MD, PhD & Farkhad Manapov MD

  2. Department of Radiation Oncology, University of Rostock, Südring 75, 18059, Rostock, Germany

    Guido Hildebrandt MD, PhD

  3. Department of Radiation Oncology, University Hospital Erlangen, Maximiliansplatz 2, 91054, Erlangen, Germany

    Rainer Fietkau MD, PhD

Authors
  1. Olarn Roengvoraphoj MD
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  2. Chukwuka Eze MD
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  3. Maximilian Niyazi MD, PhD
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  4. Minglun Li MD
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  5. Guido Hildebrandt MD, PhD
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  7. Claus Belka MD, PhD
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  8. Farkhad Manapov MD
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Correspondence to Olarn Roengvoraphoj MD.

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Conflict of interest

O. Roengvoraphoj, C. Eze, M. Niyazi, M. Li, G. Hildebrandt, R. Fietkau, C. Belka and F. Manapov declare no competing interests.

This article does not contain any studies with human participants or animals performed by any of the authors.

Additional information

Olarn Roengvoraphoj and Chukwuka Eze contributed equally to this work

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Roengvoraphoj, O., Eze, C., Niyazi, M. et al. Prognostic role of patient gender in limited-disease small-cell lung cancer treated with chemoradiotherapy. Strahlenther Onkol 193, 150–155 (2017). https://doi.org/10.1007/s00066-016-1073-x

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  • DOI: https://doi.org/10.1007/s00066-016-1073-x

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