{
  "abstract": "Background: Chemotherapy combined with immune checkpoint inhibitors is the standard first-line treatment for extensive-stage small-cell lung cancer. We evaluated whether hospital size, as a surrogate for institutional healthcare resources, was associated with treatment outcomes. Methods: This retrospective observational study used a nationwide electronic medical records database in Japan. Patients with extensive-stage small-cell lung cancer (ES-SCLC) receiving first-line platinum–etoposide plus atezolizumab or durvalumab between 2019 and 2022 were included. Patients were classified by hospital size (<500 vs. ≥500 beds) and compared after propensity score matching. The primary endpoint was time to treatment failure (TTF), and secondary endpoints included grade ≥ 3 hematological toxicities and hepatic impairments. Results: After matching, each group included 81 patients. Median TTF was 4.8 months in the <500-bed group and 4.9 months in the ≥500-bed group. In crude analyses, severe leukopenia occurred in 67.9% of patients in smaller hospitals and 45.7% in larger hospitals (RR, 0.67; 95% CI, 0.51–0.89; p = 0.007), whereas severe neutropenia occurred in 79.0% and 58.0% of patients, respectively (RR, 0.73; 95% CI, 0.59–0.91; p = 0.006). In sensitivity analyses accounting for hospital-level clustering, the association for leukopenia was maintained, whereas that for neutropenia was no longer statistically significant. Conclusions: No clear difference in TTF was observed between the hospital-size groups. Exploratory safety analyses showed differences in severe hematological toxicities, although the findings were not fully consistent after accounting for hospital-level clustering. Further studies are needed to clarify the relationship between institutional healthcare resources and treatment outcomes.",
  "abstract_shown": true,
  "affiliations": [
    "Department of Thoracic Oncology, Kansai Medical University, 2-5-1 Shinmachi, Hirakata 573-1010, Osaka, Japan",
    "Healthcare Consulting, Inc., Sumitomo Fudosan Chiyoda Fujimi Building, 1-8-19 Fujimi, Chiyoda-ku, Tokyo 102-0071, Japan",
    "Faculty of International Political Science and Economics, Nishogakusha University, 6-16 Sanbancho, Chiyoda-ku, Tokyo 102-8336, Japan"
  ],
  "article_type": null,
  "arxiv": null,
  "author_total": 6,
  "authors": [
    {
      "affs": [
        0
      ],
      "name": "Yuta Yamanaka",
      "orcid": "0009-0009-7872-4395"
    },
    {
      "affs": [
        1
      ],
      "name": "Katsuhiko Iwasaki",
      "orcid": "0000-0003-4016-4694"
    },
    {
      "affs": [
        1
      ],
      "name": "Tatsuhiro Uenishi",
      "orcid": "0000-0002-8844-4778"
    },
    {
      "affs": [
        1
      ],
      "name": "Fumika Matsushita"
    },
    {
      "affs": [
        1,
        2
      ],
      "name": "Kinya Kokubo"
    },
    {
      "affs": [
        0
      ],
      "name": "Takayasu Kurata",
      "orcid": "0000-0003-4123-3567"
    }
  ],
  "bibtex": "https://research.draconitic.com/paper/28vrsprv7mtf1.bib",
  "cited_by": 0,
  "doi": "10.3390/cancers18213555",
  "fulltext_url": null,
  "id": "28vrsprv7mtf1",
  "issns": [
    "2072-6694"
  ],
  "landing_url": "https://www.mdpi.com/2072-6694/18/21/3555",
  "language": null,
  "licence": "CC-BY-4.0",
  "licence_label": "CC BY 4.0",
  "licence_source": "article",
  "licence_url": "https://creativecommons.org/licenses/by/4.0/",
  "metadata_licence": null,
  "native_subjects": [],
  "openalex": null,
  "pdf_url": null,
  "pmcid": null,
  "pmid": null,
  "published": "2026-11-05",
  "publisher": "MDPI AG",
  "ris": "https://research.draconitic.com/paper/28vrsprv7mtf1.ris",
  "sources": [
    {
      "first_seen": "2026-11-05T12:21:23Z",
      "native_id": "10.3390/cancers18213555",
      "source": "crossref",
      "url": "https://www.mdpi.com/2072-6694/18/21/3555"
    }
  ],
  "subjects": [
    {
      "field": "medicine",
      "origin": "issn:2072-6694",
      "subfield": "oncology"
    }
  ],
  "title": "Association Between Hospital Size and Outcomes of ES-SCLC Treated with Chemo-ICI: A Real-World Database Study in Japan",
  "title_text": "Association Between Hospital Size and Outcomes of ES-SCLC Treated with Chemo-ICI: A Real-World Database Study in Japan",
  "type": "peer-reviewed",
  "updated_at": "2026-11-07T00:21:23Z",
  "url": "https://research.draconitic.com/paper/28vrsprv7mtf1",
  "venue": "Cancers",
  "versions": []
}