Prognostic value of tumor cavitation in extensive-stage small-cell lung cancer patients treated with anlotinib

  • Dongfang Chen
  • Jianlin Xu
  • Yizhuo Zhao
  • Tianqing Chu
  • Hua Zhong
  • Baohui HanEmail author
  • Runbo ZhongEmail author
Original Article – Clinical Oncology



Anlotinib is a novel multi-target tyrosine kinase inhibitor (TKI) for tumor angiogenesis and tumor cell proliferation. The efficacy of anlotinib as a third-line or beyond therapy for SCLC was confirmed in the ALTER1202 trial. For lung cancer patients treated with antiangiogenesis agents, the phenomenon of cavitation is commonly seen in the lung target lesions. The impact of tumor cavitation on survival in lung cancer patients treated with vascular-targeted therapy remains controversial. Our retrospective study was to investigate the prognostic value of tumor cavitation in extensive-stage SCLC patients treated with anlotinib.


A total of 73 extensive-stage SCLC patients confirmed by histopathology from January 2018 to January 2019 were retrospectively analyzed. All patients received anlotinib therapy at Shanghai Chest Hospital. We defined tumor cavitation of the lung target lesions as that part of solid component was changed to air-filled area according to chest CT. Progression-free survival (PFS) was calculated from the beginning of anlotinib therapy to the disease progression or the last follow-up visit.


Eleven (15.0%) patients had tumor cavitation during anlotinib therapy. The ORR of the 73 patients was 15.1%. Multivariate logistic regression analysis showed that tumor cavitation during anlotinib therapy was not associated with gender (P = 0.630), age (P = 0.190), smoking status (P = 0.165), anatomy type (P = 0.641), and the line of anlotinib therapy (P = 0.302). The median PFS of all patients was 2.6 months (95%CI 2.1–3.2). According to the univariate analysis, the median PFS in patients with and without tumor cavitation was 5.0 months and 2.2 months, respectively, and the difference was statistically significant (P = 0.041). According to the multivariate analysis, tumor cavitation was an independent factor for PFS after adjusting gender, age, smoking status, anatomy type, the line of anlotinib therapy, tumor cavitation, and response to anlotinib (adjusted HR 0.316, 95%CI 0.142–0.702; P = 0.005).


In 73 extensive-stage SCLC patients treated with anlotinib, no demographic/clinical characteristic was related to tumor cavitation, and tumor cavitation was an independent factor in predicting better PFS.


Small-cell lung cancer Anlotinib Tumor cavitation Prognosis 



We would like to thank all of the investigators for their involvement in this study.

Author contributions

All authors designed the study. Dongfang Chen collected the data. Jianlin Xu analyzed the data. Yizhuo Zhao and Tianqing Chu interpreted the results. Dongfang Chen drafted the manuscript with critical revisions from Hua Zhong, Baohui Han, Runbo Zhong. All authors approved the final version.


This work was supported by the Natural Science Foundation of Shanghai (19ZR1449700) and Western Medicine Guide Project of Shanghai Committee of Science and Technology (16411964700).

Compliance with ethical standards

Conflict of interest

All authors declare that there is no conflict of interest.

Informed consent

Informed consent was obtained from all individual participants included in the study.

Ethical approval

The study protocol was approved by the Ethics Committee of Shanghai Chest Hospital and was conducted in accordance with the Helsinki Declaration of 1964 (revised 2008).


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Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2019

Authors and Affiliations

  1. 1.Department of Pulmonary Medicine, Shanghai Chest HospitalShanghai Jiaotong UniversityShanghaiChina

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