{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,9]],"date-time":"2026-09-09T05:07:18Z","timestamp":1788930438609,"version":"build-2803163510"},"reference-count":24,"publisher":"MDPI AG","issue":"17","license":[{"start":{"date-parts":[[2026,9,6]],"date-time":"2026-09-06T00:00:00Z","timestamp":1788652800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Cancers"],"abstract":"<jats:p>Background: The comparative prognostic value of the Endothelial Activation and Stress Index (EASIX) and the Inflammatory Prognostic Index (IPI) in extensive-stage small-cell lung cancer remains unclear. This study aimed to compare the prognostic value of EASIX and IPI and assess their contribution beyond established clinical factors. Methods: This retrospective single-center study included 129 patients with de novo extensive-stage small-cell lung cancer who initiated first-line systemic therapy between December 2022 and October 2025. Pretreatment EASIX and IPI values were analyzed as log2-transformed continuous variables in multivariable Cox models. Overall survival was the primary outcome, and first-line progression-free survival was the secondary outcome. Results: During a median follow-up of 26.91 months, 116 deaths and 123 progression-or-death events occurred. Each doubling of the EASIX value was independently associated with a higher hazard of death (adjusted hazard ratio, 1.14; 95% confidence interval, 1.01\u20131.28; p = 0.019), whereas IPI was not independently associated with overall survival. Neither index was independently associated with first-line progression-free survival. Adding EASIX to the clinical model improved model fit and increased the C-index from 0.619 to 0.650, whereas IPI provided no additional prognostic contribution. Conclusions: EASIX may provide prognostic information beyond established clinical factors for overall survival in extensive-stage small-cell lung cancer. These findings warrant validation in larger multicenter cohorts.<\/jats:p>","DOI":"10.3390\/cancers18172888","type":"journal-article","created":{"date-parts":[[2026,9,7]],"date-time":"2026-09-07T09:23:37Z","timestamp":1788773017000},"page":"2888","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Prognostic and Treatment-Context Associations of EASIX and IPI in Extensive-Stage Small-Cell Lung Cancer Patients Receiving First-Line Therapy"],"prefix":"10.3390","volume":"18","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-4072-5861","authenticated-orcid":false,"given":"Hatice","family":"Ayy\u0131ld\u0131z Sevim","sequence":"first","affiliation":[{"name":"Department of Medical Oncology, Ankara Etlik City Hospital, Ankara 06170, T\u00fcrkiye"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0698-777X","authenticated-orcid":false,"given":"Galip Can","family":"Uyar","sequence":"additional","affiliation":[{"name":"Department of Medical Oncology, Ankara Etlik City Hospital, Ankara 06170, T\u00fcrkiye"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6400-317X","authenticated-orcid":false,"given":"G\u00fcner","family":"Akg\u00fcner","sequence":"additional","affiliation":[{"name":"Department of Medical Oncology, Ankara Etlik City Hospital, Ankara 06170, T\u00fcrkiye"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1561-9346","authenticated-orcid":false,"given":"Hayriye","family":"\u015eahinli","sequence":"additional","affiliation":[{"name":"Department of Medical Oncology, Ankara Etlik City Hospital, Ankara 06170, T\u00fcrkiye"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2026,9,6]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"4526","DOI":"10.1200\/JCO.2006.07.3841","article-title":"Changing face of small-cell lung cancer: Real and artifact","volume":"24","author":"Ettinger","year":"2006","journal-title":"J. Clin. Oncol."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"768","DOI":"10.1016\/j.jtho.2019.01.022","article-title":"2017\u20132018 Scientific Advances in Thoracic Oncology: Small Cell Lung Cancer","volume":"14","author":"Zimmerman","year":"2019","journal-title":"J. Thorac. Oncol."},{"key":"ref_3","first-page":"CD001990","article-title":"Chemotherapy versus best supportive care for extensive small cell lung cancer","volume":"4","author":"Sacristan","year":"2003","journal-title":"Cochrane Database Syst. Rev."},{"key":"ref_4","doi-asserted-by":"crossref","unstructured":"Go, S.I., Park, M.J., and Lee, G.W. (2021). Clinical significance of the cachexia index in patients with small cell lung cancer. BMC Cancer, 21.","DOI":"10.1186\/s12885-021-08300-x"},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"452","DOI":"10.1038\/bjc.2014.317","article-title":"The prognostic impact of the neutrophil-to-lymphocyte ratio in patients with small-cell lung cancer","volume":"111","author":"Kang","year":"2014","journal-title":"Br. J. Cancer"},{"key":"ref_6","first-page":"2075","article-title":"Sarcopenia and inflammation are independent predictors of survival in male patients newly diagnosed with small cell lung cancer","volume":"24","author":"Go","year":"2016","journal-title":"Support. Care Cancer"},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"e13122","DOI":"10.15252\/emmm.202013122","article-title":"Mechanisms of small cell lung cancer metastasis","volume":"13","author":"Ko","year":"2021","journal-title":"EMBO Mol. Med."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"360","DOI":"10.1038\/nature22323","article-title":"Intratumoural heterogeneity generated by Notch signalling promotes small-cell lung cancer","volume":"545","author":"Lim","year":"2017","journal-title":"Nature"},{"key":"ref_9","first-page":"37","article-title":"Expression of vascular endothelial growth factor (VEGF) and association with microvessel density in small-cell and non-small-cell lung carcinomas","volume":"19","author":"Stefanou","year":"2004","journal-title":"Histol. Histopathol."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"13322","DOI":"10.1038\/ncomms13322","article-title":"Vasculogenic mimicry in small cell lung cancer","volume":"7","author":"Williamson","year":"2016","journal-title":"Nat. Commun."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"23","DOI":"10.1016\/j.lungcan.2018.06.033","article-title":"Circulating endothelial cells and microparticles as diagnostic and prognostic biomarkers in small-cell lung cancer","volume":"124","author":"Najjar","year":"2018","journal-title":"Lung Cancer"},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"553","DOI":"10.1038\/s41409-019-0703-1","article-title":"EASIX and mortality after allogeneic stem cell transplantation","volume":"55","author":"Luft","year":"2020","journal-title":"Bone Marrow Transplant."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"85","DOI":"10.1038\/s41408-019-0247-z","article-title":"EASIX for prediction of survival in lower-risk myelodysplastic syndromes","volume":"9","author":"Merz","year":"2019","journal-title":"Blood Cancer J."},{"key":"ref_14","doi-asserted-by":"crossref","unstructured":"Park, S., Go, S.I., and Lee, G.W. (2022). The Endothelial Activation and Stress Index (EASIX) score is an independent prognostic factor in patients with diffuse large B-cell lymphoma. BMC Cancer, 22.","DOI":"10.1186\/s12885-022-09915-4"},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"217","DOI":"10.3233\/CBM-220032","article-title":"Endothelial activation and stress index (EASIX) as a predictive biomarker in small cell lung cancer","volume":"35","author":"Go","year":"2022","journal-title":"Cancer Biomark."},{"key":"ref_16","doi-asserted-by":"crossref","unstructured":"\u00c7\u0131takkul, \u0130., Temi, Y.B., Aytin, Z., Baydar, E., Kefeli, U., \u00c7abuk, D., and Uygun, K. (2026). EASIX Score as an Independent Prognostic Marker in De Novo Metastatic Pancreatic Cancer. Medicina, 62.","DOI":"10.3390\/medicina62030562"},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"623","DOI":"10.4111\/icu.20220204","article-title":"Prognostic value of the endothelial activation and stress index in patients with upper tract urothelial cancer undergoing radical nephroureterectomy","volume":"63","author":"Gu","year":"2022","journal-title":"Investig. Clin. Urol."},{"key":"ref_18","first-page":"5101","article-title":"A New Inflammatory Prognostic Index, Based on C-reactive Protein, the Neutrophil to Lymphocyte Ratio and Serum Albumin is Useful for Predicting Prognosis in Non-Small Cell Lung Cancer Cases","volume":"17","author":"Dirican","year":"2016","journal-title":"Asian Pac. J. Cancer Prev."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"e20343","DOI":"10.7717\/peerj.20343","article-title":"IPI score as a new prognostic index in extensive stage small cell lung cancer","volume":"13","author":"Ekinci","year":"2025","journal-title":"PeerJ"},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"3486","DOI":"10.1111\/1759-7714.14712","article-title":"Prognostic factors for survival in extensive-stage small cell lung cancer: An Italian real-world retrospective analysis of 244 patients treated over the last decade","volume":"13","author":"Longo","year":"2022","journal-title":"Thorac. Cancer"},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"1327","DOI":"10.1111\/1759-7714.14874","article-title":"Clinical impact of first-line PD-1 or PD-L1 inhibitors combined with chemotherapy in extensive-stage small cell lung cancer patients: A real-world multicenter propensity score-matched study","volume":"14","author":"Xie","year":"2023","journal-title":"Thorac. Cancer"},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"2220","DOI":"10.1056\/NEJMoa1809064","article-title":"First-Line Atezolizumab plus Chemotherapy in Extensive-Stage Small-Cell Lung Cancer","volume":"379","author":"Horn","year":"2018","journal-title":"N. Engl. J. Med."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1177\/1758835920980365","article-title":"Chemo-immunotherapy as first-line treatment for small-cell lung cancer","volume":"12","author":"Farid","year":"2020","journal-title":"Ther. Adv. Med. Oncol."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"422","DOI":"10.4143\/crt.2023.913","article-title":"The Real-World Outcome of First Line Atezolizumab in Extensive-Stage Small Cell Lung Cancer: A Multicenter Prospective Cohort Study","volume":"56","author":"Choi","year":"2024","journal-title":"Cancer Res. Treat."}],"container-title":["Cancers"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2072-6694\/18\/17\/2888\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,9,9]],"date-time":"2026-09-09T04:20:29Z","timestamp":1788927629000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2072-6694\/18\/17\/2888"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,9,6]]},"references-count":24,"journal-issue":{"issue":"17","published-online":{"date-parts":[[2026,9]]}},"alternative-id":["cancers18172888"],"URL":"https:\/\/doi.org\/10.3390\/cancers18172888","relation":{},"ISSN":["2072-6694"],"issn-type":[{"value":"2072-6694","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,9,6]]}}}