2022P - ALBA project: Prognostic impact of laterality in small cell lung cancer

Background

Due to its devastating behavior and unfavorable prognosis, SCLC is the most recalcitrant lung neuroendocrine tumor to treat. Performance status (PS), stage, and liver metastases have historically been recognized as prognostic factors in SCLC. However, these variables are unable to adequately stratify patients. Recently, we found that the laterality of primary lesions independently affected the outcome of well-differentiated lung neuroendocrine tumors, with left typical/atypical carcinoids having the worse prognosis (La Salvia A, et al. Endocrine 2022). The present analysis aims to evaluate the prognostic significance of laterality in SCLC patients.

Methods

Consecutive patients with histologically confirmed diagnosis of SCLC treated according to disease stage at 3 different Institutions from January 2020 to December 2022 and with a follow-up period of ≥ 3 months were included. Clinical and disease characteristics, date of progression, and death were collected and analyzed.

Results

A total of 140 patients were analyzed. The majority were male (57.1%), and former/current smokers (99.3%) with stage IV disease (88.5%). Primary tumor was in the right lung in 76 cases (54.2%). As expected, ECOG PS, stage, and liver metastases were significantly associated with overall survival. With a median follow-up of 11 months (range 3-28 months), patients with primary tumors in the right lung had longer survival than patients with primary tumors in the left lung (12.0 versus 9.5 months, p=0.003; HR 2.020). Similar results were observed by excluding patients with stage III disease (11.5 versus 8.8 months, p< 0.0001; HR 2.532). A multivariate model, including all significant variables in the univariate model, confirmed that left laterality represented an independent negative prognostic factor (p=0.044 in the overall population and p=0.007 considering only stage IV).

Conclusions

Our analysis showed the prognostic relevance of primary tumor laterality in SCLC for the first time. Biological differences related to differential exposure to carcinogens in tissue specimens is ongoing.

Clinical trial identification

Editorial acknowledgement

Legal entity responsible for the study

The authors.

Funding

Has not received any funding.

Disclosure

L. Landi: Non-Financial Interests, Personal, Speaker, Consultant, Advisor: Pfizer, Roche, MSD, BMS, Lilly, Amgen, Sanofi; Non-Financial Interests, Personal, Invited Speaker: Takeda, Novartis. A. Tufman: Non-Financial Interests, Personal, Speaker, Consultant, Advisor: Daiichi Sankyo, AstraZeneca, BMS, Boehringer Ingelheim, Amgen, GSK, Lilly, Bayer, Pfizer, Sanofi, Roche, Takeda, MSD. G. Minuti: Non-Financial Interests, Personal, Speaker, Consultant, Advisor: Roche, BMS, AstraZeneca, Novartis, Sanofi; Non-Financial Interests, Personal, Advisory Role: Gilead. D. Kauffmann-Guerrero: Non-Financial Interests, Personal, Speaker, Consultant, Advisor: AstraZeneca, Boehringer Ingelheim, Roche, MSD, Pfizer, BMS, GSK, Novartis, Takeda, Sanofi, Janssen. T.A. Bolt: Non-Financial Interests, Personal, Speaker, Consultant, Advisor: Lilly Germany. F.L. Cecere: Non-Financial Interests, Personal, Speaker, Consultant, Advisor: Amgen, Novartis, AstraZeneca, Takeda, Roche. F. Cappuzzo: Non-Financial Interests, Personal, Speaker, Consultant, Advisor: Roche, AstraZeneca, BMS, MSD, Lilly, Bayer, Takeda, PharmaMar, Novartis, Merck, Janssen. All other authors have declared no conflicts of interest.