In this observational study, we assessed treatment patterns and prognostic factors in patients with small cell lung cancer (SCLC) in a large state-mandated healthcare organization in Israel. Methods: All incident cases with histologically confirmed SCLC who initiated systemic anti-cancer treatment between 2011 and 2017 were identified. Treatment patterns and overall survival (OS) were evaluated for each line of therapy. Results: A total of 235 patients were identified (61% male, median age 64 years, 95% ever smokers, 64% had extensive stage). The first-line treatment was platinum-etoposide regimen for 98.7% of the cohort. The second and third-line regimen were given to 43% and 12% of patients, respectively. Mean OS for extensive and limited stage patients was 9.1 and 23.5 months respectively. In a multivariable model, increased risk for mortality was observed among patients with an ECOG performance status (PS) of 2 compared to a PS of 0-1 for the extensive stage patients (Hazard ratio (HR) = 1.63, 95% confidence ratios (CI): 1.00-2.65); and for males compared to females for the limited stage patients (HR = 2.17; 95% CI: 1.12-4.20). Regarding all 2nd line patients in a multivariable model incorporating relevant confounding factors, demonstrated a significantly better outcome with platinum-based regimens compared to topotecan. Median survival after initiation of 2nd line in platinum-sensitive patients was longer (p = 0.056) for those re-challenged with platinum-based regimen (n = 7): 6.8mo (6.1-not reported (NR)), compared with those switched to a different treatment (n = 27): 4.5 mo (2.6-6.6) for extensive stage patients, and a non-significant difference was also observed for limited stage patients. Conclusion: To our knowledge, this is one of the largest real-world studies of SCLC patients. OS for SCLC patients was similar to that reported in clinical trials. PS for extensive stage patients and sex for limited stage patients were significant correlates of prognosis. Re-challenge of the platinum-based doublet was associated with longer OS compared to switching treatment in extensive stage patients.

中文翻译：

---

小细胞肺癌患者的真实世界分析：预后因素和治疗结果

在这项观察性研究中，我们评估了以色列一家大型国家授权医疗机构的小细胞肺癌 (SCLC) 患者的治疗模式和预后因素。方法：确定了 2011 年至 2017 年间开始全身抗癌治疗的所有经组织学证实的 SCLC 事件病例。对每条治疗线的治疗模式和总生存期 (OS) 进行了评估。结果：共确定了 235 名患者（61% 为男性，中位年龄 64 岁，95% 曾吸烟，64% 为广泛期）。98.7% 的队列的一线治疗是铂类依托泊苷方案。分别有 43% 和 12% 的患者接受了二线和三线方案。广泛期和局限期患者的平均 OS 分别为 9.1 和 23.5 个月。在多变量模型中，与广泛期患者的 PS 为 0-1 相比，ECOG 体能状态 (PS) 为 2 的患者的死亡风险增加（危险比 (HR) = 1.63，95% 置信比 (CI)：1.00- 2.65); 对于局限期患者，男性与女性相比（HR = 2.17；95% CI：1.12-4.20）。对于纳入相关混杂因素的多变量模型中的所有二线患者，与拓扑替康相比，基于铂的方案显示出明显更好的结果。铂类敏感患者开始二线治疗后的中位生存期（p = 0.056）对于再次接受铂类治疗的患者（n = 7）：6.8mo（6.1-未报告（NR）），与那些患者相比切换到不同的治疗（n = 27）：广泛期患者为 4.5 个月（2.6-6.6），对于局限期患者也观察到非显着差异。结论：据我们所知，这是针对 SCLC 患者的最大的真实世界研究之一。SCLC 患者的 OS 与临床试验中报告的相似。广泛期患者的 PS 和局限期患者的性别与预后显着相关。在广泛期患者中，与转换治疗相比，再次挑战铂类双药与更长的 OS 相关。