Aims: This study aimed at developing a scoring system (EAST score) to predict recurrence after chemoradiotherapy in limited-stage small-cell lung cancer (LS-SCLC).
Patients & methods: Treatment-naïve LS-SCLC patients receiving concurrent chemoradiotherapy (CCRT) (N = 234) or sequential chemoradiotherapy (N = 53) were retrospectively reviewed. Using data from CCRT population, clinical and radiological variables associated with disease progression were identified. Selected variables were assigned numerical scores based on their estimated hazard ratios (HRs), and the EAST score was established.
Results: EAST score incorporated N3 disease and serum biomarkers (lactate dehydrogenase, pro-gastrin-releasing peptide, and cytokeratin-19 fragment). In the CCRT population, progression-free survival (PFS) was significantly shorter in the high-risk group (EAST score ≥ 2) than the low-risk group (EAST score ≤ 1) (median, 9.4 months vs. 20.6 months; HR [95% confidence interval (CI)], 2.09 [1.50-2.91]). As for the model performance, the 1- and 2-year area under the curve values for PFS were 0.68 and 0.65, respectively. Overall survival was also shorter in the high-risk group (HR [95% CI], 1.49 [1.02-2.16]). Similar trends were observed in the sequential chemoradiotherapy population (HR for PFS [95% CI], 2.43 [1.07-5.53]).
Conclusions: EAST score effectively predicts recurrence risk in LS-SCLC, demonstrating the necessity for developing new treatment strategies for high-risk patients.
Keywords: Chemoradiotherapy; EAST score; limited-stage; prognostic model; small-cell lung cancer.
What is this article about? This study introduced the EAST score, a new system to predict recurrence risk in people with limited-stage small-cell lung cancer (LS-SCLC) receiving chemoradiotherapy. Chemoradiotherapy is the main treatment for LS-SCLC, but physicians do not have a good way to guess how well it will work for each patient. Using information from LS-SCLC patients, the researchers found certain biomarkers that are linked to the cancer recurrence. The EAST score was created using these biomarkers.What were the results? Out of 1,496 patients with SCLC, 234 with LS-SCLC had treatment with concurrent chemoradiotherapy, and 53 had sequential chemoradiotherapy. The EAST score included N3 disease and some blood test results (lactate dehydrogenase, pro-gastrin-releasing peptide, and cytokeratin-19 fragment). In patients who had concurrent chemoradiotherapy, those with a high-risk EAST score (≥2 points) had short progression-free survival (9.4 months on average) compared to the low-risk patients (≤1 point, 20.6 months). High-risk patients also had short overall survival (34.2 months) compared to low-risk patients (53.0 months on average). Similar results were seen in patients who had sequential chemoradiotherapy.What do the results of the study mean? This study shows that the EAST score is helpful for physicians to predict cancer outcomes using results of routine tests. Patients with a high-risk score might need stronger or different treatments to help them live longer.