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Development and validation of a nomogram for assessing survival in extensive-stage small-cell lung cancer patients with superior vena cava syndrome referred for thoracic radiotherapy: a comparison of upfront vs. consolidative approaches

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Abstract

Purpose

This study sought to design and validate a nomogram capable of predicting outcomes in extensive-stage small-cell lung cancer (ES-SCLC) patients with superior vena cava syndrome (SVCS) based upon the timing of their radiotherapy treatment.

Methods

We retrospectively analyzed data from 175 ES-SCLC patients with SCVS, comparing outcomes between those that underwent upfront thoracic radiotherapy (initial radiotherapy with simultaneous chemotherapy) and those that underwent consolidative thoracic radiotherapy (following 4–6 cycles of chemotherapy). Significant predictors of patient outcomes were identified using a Cox proportional hazard model and were used to construct our nomogram. This model was subsequently validated using receiver operating characteristic (ROC) curves, concordance index (C-index) values, and a risk classification system in order to evaluate its discriminative and predictive accuracy.

Results

The overall survival (OS) of ES-SCLC patients with SVCS that underwent chemotherapy (CT), consolidative thoracic radiotherapy (cc-TRT), and upfront thoracic radiotherapy (cu-TRT) was 8.2, 11.7, and 14.9 months, respectively (p < 0.001), with respective progression-free survival (PFS) durations of 3.3, 5.0, and 7.3 months (p < 0.001). A multivariate regression analysis revealed age, gender, ECOG performance status, sites of tumor metastasis, and treatment approach to all be independent predictors of survival outcomes. A nomogram was therefore developed incorporating these factors. C‑index values upon internal and external validation of this nomogram were 0.7625 and 0.7959, respectively, and ROC and calibration curves revealed this model to be accurate and consistent.

Conclusions

We found that upfront thoracic radiotherapy in combination with chemotherapy may be associated with a positive impact on outcomes in ES-SCLC patients with SVCS.

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References

  1. Kalemkerian GP (2016) Small cell lung cancer. Semin Respir Crit Care Med 37(5):783–796

    Article  Google Scholar 

  2. Zhang X, Yu J, Zhu H, Meng X, Li M, Jiang L, Ding X, Sun X (2017) Consolidative thoracic radiotherapy for extensive stage small cell lung cancer. Oncotarget 8(13):22251–22261. https://doi.org/10.18632/oncotarget.14759

    Article  PubMed  PubMed Central  Google Scholar 

  3. Chen Y, Li J, Hu Y, Zhang Y, Lin Z, Zhao Z, Jiao S (2016) Prophylactic cranial irradiation could improve overall survival in patients with extensive small cell lung cancer : a retrospective study. Strahlenther Onkol 192(12):905–912. https://doi.org/10.1007/s00066-016-1038-0

    Article  PubMed  Google Scholar 

  4. Farago AF, Keane FK (2018) Current standards for clinical management of small cell lung cancer. Transl Lung Cancer Res 7(1):69–79. https://doi.org/10.21037/tlcr.2018.01.16

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  5. Slotman BJ, van Tinteren H, Praag JO, Knegjens JL, El Sharouni SY, Hatton M, Keijser A, Faivre-Finn C, Senan S (2015) Use of thoracic radiotherapy for extensive stage small-cell lung cancer: a phase 3 randomised controlled trial. Lancet 385(9962):36–42. https://doi.org/10.1016/S0140-6736(14)61085-0

    Article  PubMed  Google Scholar 

  6. Socinski MA, Smit EF, Lorigan P, Konduri K, Reck M, Szczesna A, Blakely J, Serwatowski P, Karaseva NA, Ciuleanu T, Jassem J, Dediu M, Hong S, Visseren-Grul C, Hanauske A‑R, Obasaju CK, Guba SC, Thatcher N (2009) Phase III study of pemetrexed plus carboplatin compared with etoposide plus carboplatin in chemotherapy-naive patients with extensive-stage small-cell lung cancer. J Clin Oncol 27(28):4787–4792. https://doi.org/10.1200/JCO.2009.23.1548

    Article  CAS  PubMed  Google Scholar 

  7. Lu YJ, Yang Y, Yuan YH, Wang WJ, Cui MT, Tang HY, Duan WM (2020) A novel nomogram based on SEER database for the prediction of liver metastasis in patients with small-cell lung cancer. Ann Palliat Med. https://doi.org/10.21037/apm-20-886

    Article  PubMed  Google Scholar 

  8. Wudel LJ, Nesbitt JC (2001) Superior vena cava syndrome. Curr Treat Options Oncol 2(1):77–91

    Article  Google Scholar 

  9. Wang Z‑B, Ning F‑L, Wang X‑L, Cheng Y‑F, Dong X‑J, Liu C‑M, Chen S‑S (2015) Radiation dose is associated with prognosis of small cell lung cancer with superior vena cava syndrome. Int J Clin Exp Med 8(3):4263–4268

    PubMed  PubMed Central  Google Scholar 

  10. Arinc S, Gonlugur U, Devran O, Erdal N, Ece F, Ertugrul M, Derince D, Oruc O, Hazar A (2010) Prognostic factors in patients with small cell lung carcinoma. Med Oncol 27(2):237–241. https://doi.org/10.1007/s12032-009-9198-8

    Article  CAS  PubMed  Google Scholar 

  11. Christodolou C, Pavlidis N, Samantas E, Fountzilas G, Kouvatseas G, Pagdatoglou K, Palamidas F, Nikolaidis C, Angelidou M, Kalofonos HP, Kosmidis P, Skarlos DV (2002) Prognostic factors in Greek patients with small cell lung cancer (SCLC). A hellenic cooperative oncology group study. Anticancer Res 22(6):3749–3757

    CAS  PubMed  Google Scholar 

  12. Rowell NP, Gleeson FV (2002) Steroids, radiotherapy, chemotherapy and stents for superior vena caval obstruction in carcinoma of the bronchus: a systematic review. Clin Oncol (R Coll Radiol) 14(5):338–351. https://doi.org/10.1053/clon.2002.0095

    Article  CAS  Google Scholar 

  13. Wendt TG (2001) Thoracic radiotherapy in the treatment of limited disease of small-cell cancer: sequence and fractionation. Cancer Treat Res 33(1):S143–S146

    Google Scholar 

  14. Hu X, Xia B, Bao Y, Xu YJ, Wang J, Ma HL, Peng F, Jin Y, Fang M, Tang HR, Chen MY, Dong BQ, Jin JN, Fu XL, Chen M (2020) Timing of thoracic radiotherapy is more important than dose intensification in patients with limited-stage small cell lung cancer: a parallel comparison of two prospective studies. Strahlenther Onkol 196(2):172–181. https://doi.org/10.1007/s00066-019-01539-1

    Article  PubMed  Google Scholar 

  15. Slotman BJ, Faivre-Finn C, van Tinteren H, Keijser A, Praag J, Knegjens J, Hatton M, van Dam I, van der Leest A, Reymen B, Stigt J, Haslett K, Tripathi D, Smit EF, Senan S (2017) Which patients with ES-SCLC are most likely to benefit from more aggressive radiotherapy: a secondary analysis of the phase III CREST trial. Cancer Treat Res 108:150–153. https://doi.org/10.1016/j.lungcan.2017.03.007

    Article  Google Scholar 

  16. Putora PM, Glatzer M, De Ruysscher D, Faivre-Finn C, Belderbos J, Besse B, Blackhall F, Califano R, Cappuzzo F, De Marinis F, Dziadiuszko R, Felip E, Früh M, Garrido P, Le Pechoux C, McDonald F, Nestle U, Novello S, Brien MO, Paz Ares L, Peeters S, Pöttgen C, Ramella S, Reck M, Troost EGC, Van Houtte P, Westeel V, Widder J, Mornex F, Slotman BJ (2019) Consolidative thoracic radiotherapy in stage IV small cell lung cancer: selection of patients amongst European IASLC and ESTRO experts. Radiother Oncol 135:74–77. https://doi.org/10.1016/j.radonc.2019.02.010

    Article  PubMed  Google Scholar 

  17. Klautke G, Sauer R, Fietkau R (2008) Combined treatment modality in small cell lung cancer : the impact of radiotherapy on survival. Strahlenther Onkol 184(2):61–66. https://doi.org/10.1007/s00066-008-1839-x

    Article  PubMed  Google Scholar 

  18. Zelen M (1973) Keynote address on biostatistics and data retrieval. Cancer Chemother Rep 3 4(2):31–42

    CAS  PubMed  Google Scholar 

  19. NCCN (2020) NCCN clinical practice guidelines in oncology: small cell lung cancer (version 3.2020)

    Google Scholar 

  20. Pignon JP, Arriagada R, Ihde DC, Johnson DH, Perry MC, Souhami RL, Brodin O, Joss RA, Kies MS, Lebeau B (1992) A meta-analysis of thoracic radiotherapy for small-cell lung cancer. N Engl J Med 327(23):1618–1624

    Article  CAS  Google Scholar 

  21. Warde P, Payne D (1992) Does thoracic irradiation improve survival and local control in limited-stage small-cell carcinoma of the lung? A meta-analysis. J Clin Oncol 10(6):890–895

    Article  CAS  Google Scholar 

  22. De Ruysscher D, Lueza B, Le Péchoux C, Johnson DH, O’Brien M, Murray N, Spiro S, Wang X, Takada M, Lebeau B, Blackstock W, Skarlos D, Baas P, Choy H, Price A, Seymour L, Arriagada R, Pignon JP (2016) Impact of thoracic radiotherapy timing in limited-stage small-cell lung cancer: usefulness of the individual patient data meta-analysis. Ann Oncol 27(10):1818–1828. https://doi.org/10.1093/annonc/mdw263

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  23. Pijls-Johannesma M, De Ruysscher D, Vansteenkiste J, Kester A, Rutten I, Lambin P (2007) Timing of chest radiotherapy in patients with limited stage small cell lung cancer: a systematic review and meta-analysis of randomised controlled trials. Cancer Treat Rev 33(5):461–473

    Article  Google Scholar 

  24. Takada M, Fukuoka M, Kawahara M, Sugiura T, Yokoyama A, Yokota S, Nishiwaki Y, Watanabe K, Noda K, Tamura T, Fukuda H, Saijo N (2002) Phase III study of concurrent versus sequential thoracic radiotherapy in combination with cisplatin and etoposide for limited-stage small-cell lung cancer: results of the Japan clinical oncology group study 9104. J Clin Oncol 20(14):3054–3060

    Article  CAS  Google Scholar 

  25. Higgins KA, Simone CB, Amini A, Chetty IJ, Donington J, Edelman MJ, Chun SG, Kestin LL, Movsas B, Rodrigues GB, Rosenzweig KE, Slotman BJ, Rybkin II II, Wolf A, Chang JY (2020) American radium society appropriate use criteria on radiation therapy for extensive-stage SCLC. J Thorac Oncol. https://doi.org/10.1016/j.jtho.2020.09.013

    Article  PubMed  Google Scholar 

  26. Jeremic B, Shibamoto Y, Nikolic N, Milicic B, Milisavljevic S, Dagovic A, Aleksandrovic J, Radosavljevic-Asic G (1999) Role of radiation therapy in the combined-modality treatment of patients with extensive disease small-cell lung cancer: a randomized study. J Clin Oncol 17(7):2092–2099

    Article  CAS  Google Scholar 

  27. Gore EM, Hu C, Sun AY, Grimm DF, Ramalingam SS, Dunlap NE, Higgins KA, Werner-Wasik M, Allen AM, Iyengar P, Videtic GMM, Hales RK, McGarry RC, Urbanic JJ, Pu AT, Johnstone CA, Stieber VW, Paulus R, Bradley JD (2017) Randomized phase II study comparing prophylactic cranial irradiation alone to prophylactic cranial irradiation and consolidative extracranial irradiation for extensive-disease small cell lung cancer (ED SCLC): NRG oncology RTOG 0937. J Thorac Oncol 12(10):1561–1570. https://doi.org/10.1016/j.jtho.2017.06.015

    Article  PubMed  PubMed Central  Google Scholar 

  28. Palma DA, Warner A, Louie AV, Senan S, Slotman B, Rodrigues GB (2016) Thoracic radiotherapy for extensive stage small-cell lung cancer: a meta-analysis. Clin Lung Cancer 17(4):239–244. https://doi.org/10.1016/j.cllc.2015.09.007

    Article  PubMed  Google Scholar 

  29. Beck C, Berberich W, Bauknecht A, Schnabel K (1990) The superior vena cava syndrome as an emergency in radiotherapy. Strahlenther Onkol 166(12):798–802

    CAS  PubMed  Google Scholar 

  30. Maddox AM, Valdivieso M, Lukeman J, Smith TL, Barkley HE, Samuels ML, Bodey GP (1983) Superior vena cava obstruction in small cell bronchogenic carcinoma. Clinical parameters and survival. Cancer 52(11):2165–2172

    Article  CAS  Google Scholar 

  31. Sculier JP, Evans WK, Feld R, DeBoer G, Payne DG, Shepherd FA, Pringle JF, Yeoh JL, Quirt IC, Curtis JE (1986) Superior vena caval obstruction syndrome in small cell lung cancer. Cancer 57(4):847–851

    Article  CAS  Google Scholar 

  32. Zhang H, Deng L, Wang X, Wang D, Teng F, Yu J (2019) Metastatic location of extensive stage small-cell lung cancer: implications for thoracic radiation. J Cancer Res Clin Oncol 145(10):2605–2612. https://doi.org/10.1007/s00432-019-03000-3

    Article  CAS  PubMed  Google Scholar 

  33. Nakazawa K, Kurishima K, Tamura T, Kagohashi K, Ishikawa H, Satoh H, Hizawa N (2012) Specific organ metastases and survival in small cell lung cancer. Oncol Lett 4(4):617–620

    Article  Google Scholar 

  34. Riihimäki M, Hemminki A, Fallah M, Thomsen H, Sundquist K, Sundquist J, Hemminki K (2014) Metastatic sites and survival in lung cancer. Cancer Treat Res 86(1):78–84. https://doi.org/10.1016/j.lungcan.2014.07.020

    Article  Google Scholar 

  35. Gao H, Dang Y, Qi T, Huang S, Zhang X (2020) Mining prognostic factors of extensive-stage small-cell lung cancer patients using nomogram model. Medicine (Baltimore) 99(33):e21798. https://doi.org/10.1097/MD.0000000000021798

    Article  CAS  Google Scholar 

  36. Wu C, Li F, Jiao S‑C (2012) Prognostic factors for survival of patients with extensive stage small cell lung cancer—a retrospective single institution analysis. Asian Pac J Cancer Prev 13(10):4959–4962

    Article  Google Scholar 

  37. Hong X, Xu Q, Yang Z, Wang M, Yang F, Gao Y, Zhou F, Wang L, Liu B, Chen G (2018) The value of prognostic factors in Chinese patients with small cell lung cancer: a retrospective study of 999 patients. Clin Respir J 12(2):433–447. https://doi.org/10.1111/crj.12534

    Article  CAS  PubMed  Google Scholar 

  38. Horn L, Mansfield AS, Szczesna A, Havel L, Krzakowski M, Hochmair MJ, Huemer F, Losonczy G, Johnson ML, Nishio M, Reck M, Mok T, Lam S, Shames DS, Liu J, Ding B, Lopez-Chavez A, Kabbinavar F, Lin W, Sandler A, Liu SV, IMpower133 Study Group (2018) First-line atezolizumab plus chemotherapy in extensive-stage small-cell lung cancer. N Engl J Med 379(23):2220–2229. https://doi.org/10.1056/NEJMoa1809064

    Article  CAS  PubMed  Google Scholar 

  39. Paz-Ares L, Dvorkin M, Chen Y, Reinmuth N, Hotta K, Trukhin D, Statsenko G, Hochmair MJ, Özgüroğlu M, Ji JH, Voitko O, Poltoratskiy A, Ponce S, Verderame F, Havel L, Bondarenko I, Kazarnowicz A, Losonczy G, Conev NV, Armstrong J, Byrne N, Shire N, Jiang H, Goldman JW, Batagelj E, Casarini I, Pastor AV, Sena SN, Zarba JJ, Burghuber O, Hartl S, Hochmair MJ, Lamprecht B, Studnicka M, Schlittler AL, Martinelli de Oliveira AF, Calabrich A, Colagiovanni Girotto G, Dos Reis P, Gorini FNC, Martins De Marchi RP, Serodio da Rocha Baldotto C, Sette C, Zukin M, Conev NV, Dudov A, Ilieva R, Koynov K, Krasteva R, Tonev I, Valev S, Venkova V, Bi M, Chen C, Chen Y, Chen Z, Fang J, Feng J, Han Z, Hu J, Hu Y, Li W, Liang Z, Lin Z, Ma R, Ma S, Nan K, Shu Y, Wang K, Wang M, Wu G, Yang N, Yang Z, Zhang H, Zhang W, Zhao J, Zhao Y, Zhou C, Zhou J, Zhou X, Havel L, Kolek V, Koubkova L, Roubec J, Skrickova J, Zemanova M, Chouaid C, Hilgers W, Lena H, Moro-Sibilot D, Robinet G, Souquet P‑J, Alt J, Bischoff H, Grohe C, Laack E, Lang S, Panse J, Reinmuth N, Schulz C, Bogos K, Csánky E, Fülöp A, Horváth Z, Kósa J, Laczó I, Losonczy G, Pajkos G, Pápai Z, Pápai Székely Z, Sárosi V, Somfay A, Somogyiné Ezer É, Telekes A, Bar J, Gottfried M, Heching NI, Zer Kuch A, Bartolucci R, Bettini AC, Delmonte A, Garassino MC, Minelli M, Roila F, Verderame F, Atagi S, Azuma K, Goto H, Goto K, Hara Y, Hayashi H, Hida T, Hotta K, Kanazawa K, Kanda S, Kim YH, Kuyama S, Maeda T, Morise M, Nakahara Y, Nishio M, Nogami N, Okamoto I, Saito H, Shinoda M, Umemura S, Yoshida T, Claessens N, Cornelissen R, Heniks L, Hiltermann J, Smit E, Staal van den Brekel A, Kazarnowicz A, Kowalski D, Mańdziuk S, Mróz R, Wojtukiewicz M, Ciuleanu T, Ganea D, Ungureanu A, Dvorkin M, Luft A, Moiseenko V, Poltoratskiy A, Sakaeva D, Smolin A, Statsenko G, Vasilyev A, Vladimirova L, Anasina I, Chovanec J, Demo P, Godal R, Kasan P, Stresko M, Urda M, Cho EK, Ji JH, Kim J‑H, Kim S‑W, Lee G‑W, Lee J‑S, Lee KH, Lee KH, Lee YG, Molla AIM, Domine Gomez M, Delgado Mingorance IJ, Isla Casado D, Lopez Brea M, Majem Tarruella M, Morán Bueno T, Navarro Mendivil A, Rodríguez P‑AL, Ponce Aix S, Garcia Campelo RM, Chang G‑C, Chen Y‑H, Chiu C‑H, Hsia T‑C, Lee K‑Y, Li C‑T, Wang C‑C, Wei Y‑F, Wu S‑Y, Alacacıoğlu A, Çiçin I, Demirkazik A, Erman M, Göksel T, Özgüroğlu M, Adamchuk H, Bondarenko I, Kolesnik O, Kryzhanivska A, Ostapenko Y, Shevnia S, Shparyk Y, Trukhin D, Ursol G, Voitko N, Voitko O, Vynnychenko I, Babu S, Chen Y, Chiang A, Chua W, Dakhil S, Dowlati A, Goldman JW, Haque B, Jamil R, Knoble J, Lakhanpal S, Mi K, Nikolinakos P, Powell S, Ross H, Schaefer E, Schneider J, Spahr J, Spigel D, Stilwill J, Sumey C, Williamson M (2019) Durvalumab plus platinum–etoposide versus platinum–etoposide in first-line treatment of extensive-stage small-cell lung cancer (CASPIAN): a randomised, controlled, open-label, phase 3 trial. Lancet 394(10212):32222–32226. https://doi.org/10.1016/s0140-6736

    Article  Google Scholar 

  40. Slotman B, Faivre-Finn C, Kramer G, Rankin E, Snee M, Hatton M, Postmus P, Collette L, Musat E, Senan S (2007) Prophylactic cranial irradiation in extensive small-cell lung cancer. N Engl J Med 357(7):664–672

    Article  CAS  Google Scholar 

  41. Takahashi T, Yamanaka T, Seto T, Harada H, Nokihara H, Saka H, Nishio M, Kaneda H, Takayama K, Ishimoto O, Takeda K, Yoshioka H, Tachihara M, Sakai H, Goto K, Yamamoto N (2017) Prophylactic cranial irradiation versus observation in patients with extensive-disease small-cell lung cancer: a multicentre, randomised, open-label, phase 3 trial. Lancet Oncol 18(5):663–671. https://doi.org/10.1016/S1470-2045(17)30230-9

    Article  PubMed  Google Scholar 

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Funding

This project was supported by a grant from Sichuan Provincial Science and Technology Funding to Youling Gong (2018SZ0184).

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Authors and Affiliations

  1. Department of Thoracic Oncology, Cancer Center and State Key Laboratory of Biotherapy, West China Hospital, Sichuan University, 610041, Chengdu, China

    Ting Mei, Weigang Xiu, Xuexi Yang, Yang Yu, Yong Xu, Lin Zhou, Xiaojuan Zhou, Yongmei Liu, Bingwen Zou, Jianxin Xue, You Lu & Youling Gong

  2. Department of Oncology, Chengdu Jinniu District People’s Hospital, 610031, Chengdu, China

    Xiaoman Tian

  3. Department of Oncology, Sichuan Provincial People’s Hospital, 610072, Chengdu, China

    Rui Ao

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  1. Ting Mei
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  2. Weigang Xiu
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Contributions

Youling Gong conceived and designed the study. Ting Mei, Weigang Xiu, Xuexi Yang, and Xiaoman Tian collected the data. Ting Mei and Youling Gong analyzed and interpreted the data and drafted the article. Yang Yu, Yong Xu, Lin Zhou, Xiaojuan Zhou, Yongmei Liu, Bingwen Zou, Jianxin Xue, Xiaoman Tian, Rui Ao, You Lu critically revised the paper. All of the authors approved the final submitted version.

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Correspondence to Youling Gong.

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Conflict of interest

T. Mei, W. Xiu, X. Yang, X. Tian, Y. Yu, Y. Xu, L. Zhou, X. Zhou, Y. Liu, B. Zou, J. Xue, R. Ao, Y. Lu and Y. Gong declare that they have no competing interests.

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This work has been selected to be presented partly in digital poster form at the IASLC 2020 World Conference on Lung Cancer, 2020.

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Mei, T., Xiu, W., Yang, X. et al. Development and validation of a nomogram for assessing survival in extensive-stage small-cell lung cancer patients with superior vena cava syndrome referred for thoracic radiotherapy: a comparison of upfront vs. consolidative approaches. Strahlenther Onkol 197, 1072–1083 (2021). https://doi.org/10.1007/s00066-021-01783-4

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