Real-world outcomes in limited-stage SCLC: A 10-year retrospective analysis.

Abstract

Background: Small cell lung cancer (SCLC) comprises 10-15% of lung cancers and is characterised by rapid progression and early metastasis. Limited-stage SCLC (LS-SCLC) accounts for -30% of cases and is typically treated with concurrent chemoradiotherapy, yet long-term outcomes remain suboptimal. The ADRIATIC trial demonstrated improved overall survival (OS) with consolidation durvalumab, signalling a shift in LS-SCLC management. We conducted a retrospective study to compare our patient outcomes with the ADRIATIC control arm, providing a benchmark to assess future immunotherapy benefit. Method(s): We reviewed records of 36 adults with LS-SCLC treated with platinum- etoposide chemotherapy and concurrent radiotherapy at a tertiary hospital in Melbourne, Australia (2015-2024). Demographic, clinical, treatment, and outcome data were collected. Kaplan-Meier methods were used to estimate survival as a function of time. Cox proportional hazards regression was used to assess the factors associated with OS and progression-free survival (PFS). Result(s): Median OS was 61 months (7.6 to 138.8 months), and 5-year overall survival was 54.9%. 16 patients (44%) received PCI. Cox regression identified poorer initial treatment response (stable/progressive disease vs complete/partial response) as associated with worse OS (HR 15.09, p<0.001) and PFS (HR 3.73, p = 0.003). Elevated baseline LDH trended towards shorter OS (HR 1.002, p = 0.054). For PFS, favourable factors included >20 pack-year smoking history (HR 0.32, p = 0.02) and higher BMI (HR 0.89, p = 0.02). Higher neutrophil-to-lymphocyte ratio (NLR) predicted shorter PFS (HR 1.05, p = 0.049), as did higher CRP (HR 1.01, p = 0.03, n = 16). Amongst relapsed patients, 16 had lung (locoregional) recurrence and 12 had distant metastases. Conclusion(s): In this 10-year LS-SCLC cohort, best initial radiological response, BMI, smoking history and NLR were significantly associated with survival. As durvalumab becomes adopted into standard practice, our study provides a reference point for assessing its benefit and for validating prognostic biomarkers in a real-world cohort.