Prognostic value of the StAN score in elderly small cell lung cancer

Lung cancer, the leading cause of cancer-related mortality, includes small-cell lung cancer (SCLC), which accounts for 15% of cases. The median age of lung cancer diagnosis is 71, highlighting the need for accessible prognostic tools in elderly patients. The prognostic nutritional index (PNI) has shown promise in predicting survival in various cancers. This study evaluates the performance of a PNI-based novel scoring system in elderly SCLC patients. We analyzed 117 patients aged ≥ 65 diagnosed with SCLC between 2007 and 2023. Data on age, Eastern Cooperative Oncology Group Scale (ECOG) performance status, hemoglobin levels, disease stage, and PNI were collected. The StAN score, incorporating stage (extensive vs. limited), hemoglobin (normal vs. low), and PNI (< median vs. ≥ median), was derived from multivariate analyses. Patients were classified into low- and high-risk categories. Kaplan-Meier and Cox models assessed overall survival (OS) and progression-free survival (PFS). The median age was 71 years, with 89.7% male patients. Median follow-up was 12.4 months. Patients with low PNI had shorter OS (7.6 vs. 18.2 months, p < 0.001) and PFS (5.4 vs. 10.3 months, p < 0.001). High-risk patients, based on the StAN score, had shorter OS (7.8 vs. 18.5 months, HR 2.38, p < 0.001) and PFS (5.4 vs. 10.3 months, HR 2.29, p < 0.001). Harrell's C indices for predicting OS and PFS were 0.72 and 0.73, respectively. In conclusion, the StAN score is a reliable prognostic tool for elderly SCLC patients and may help stratify patients and improve treatment strategies.