Elsevier

Lung Cancer

Volume 88, Issue 1, April 2015, Pages 52-56
Lung Cancer

Role of surgical resection for patients with limited disease-small cell lung cancer

https://doi.org/10.1016/j.lungcan.2015.01.010Get rights and content

Highlights

  • We examined the outcomes of 277 patients with LD-SCLC.

  • Surgery is effective for the patients with stage I and some cases of stage II or III.

  • The outcomes of treatment for LD-SCLC have been improved beginning in the 2000s.

Abstract

Objectives

Although chemotherapy and radiotherapy are recommended for patients with limited disease small cell lung cancer (LD-SCLC), several series have reported favorable survival outcomes even in patients with stages II and III disease who underwent surgical resection. The purpose of this study is to compare the outcomes of the use of surgical resection to the other conventional non-surgical treatments in patients with LD-SCLC with respect to each clinical stage.

Materials and methods

We retrospectively reviewed 277 patients who received treatment for LD-SCLC and compared the outcomes of the use of surgical resection to the other conventional non-surgical treatments.

Results

The clinical stage was stage I in 50 cases (18%), stage II in 53 cases (19%) and stage III in 174 cases (63%). Eighty-eight patients received surgical resection and 189 patients were treated with non-surgical treatment. Surgery was performed in 44 patients (88%) with stage I, 27 patients (52%) with stage II and 17 patients (10%) with stage III disease. The five-year survival rates of the patients according to clinical stage were 58% in stage I, 29% in stage II and 18% in stage III. The five-year survival rates of the patients with and without surgical resection according to clinical stage were as follows: 62% and 25% in stage I (p < 0.01), 33% and 24% in stage II (p = 0.95), 18% and 18% in stage III (p = 0.35), respectively. In 44 propensity score-matched pairs with stages II and III disease, including matching for variables such as age, gender and the PS, the five-year survival rates was better in patients with surgical resection than in those without surgery (p = 0.04).

Conclusion

Surgical resection is effective for the patients with stage I LD-SCLC and some cases of stage II or III disease.

Introduction

Lung cancer continues to be the most common type of cancer, with approximately 1.6 million new cases diagnosed each year in the world [1]. This number is predicted to increase worldwide [1]. Small cell lung cancer (SCLC) represents 10–15% of all lung cancers, and the incidence of SCLC has been slowly decreasing over the past few years in the United States and Japan [2], [3]. SCLC is one of the most aggressive cancers; therefore, more than 60% of SCLC is already extended disease at diagnosis, and stage I disease is diagnosed in less than 5% of the patients with SCLC [4]. On the other hand, due to the advances in new and more powerful diagnostic tools, such as chest computed tomography (CT) and positron emission tomography (PET), an increase in the detection of SCLC as small nodules is expected.

Generally, due to SCLC responds chemotherapy and radiotherapy, surgical treatment is considered to be an option for early stage SCLC, while its clinical benefit is considered to be limited in patients with more advanced disease [5], [6]. The most recent National Comprehensive Cancer Network guidelines recommend that patients with SCLC that is clinical stage I (T1-2, N0) after a standard staging evaluation may be considered for surgical resection [5]. Furthermore, this guideline states that patients with disease exceeding T1–T2, N0 do not benefit from surgery [5]. The recommended treatment in cases of limited stage excess T1–T2, N0 with a good PS is chemotherapy with concurrent radiotherapy [5]. Similarly, according to the American College of Chest Physicians guidelines, in patients with clinical stage I SCLC after a thorough distant and invasive mediastinal stage evaluation, surgical resection is suggested over non-surgical treatment based on grade 2C evidence [6]. On the other hand, several authors reported favorable results for surgical resection not only for stage I disease but also for more advanced disease [7], [8], [9], [10], [11], [12].

In this study, we retrospectively compared the outcomes of the use of surgical resection compared to the other conventional non-surgical treatments in patients with LD-SCLC with respect to each clinical stage.

Section snippets

Patients and methods

From 1974 through 2011, 605 consecutive patients were diagnosed with SCLC at the National Kyushu Cancer Center. Of those, 277 patients were treated for LD-SCLC. We retrospectively reviewed and analyzed the outcomes of these cases in terms of the role of surgical resection. Demographic, clinical and treatment data were abstracted from an institutional database that included all patients who had received treatment. The definition of LD-SCLC in this study was based on the International Association

Results

The age of the patients ranged from 38 to 89 years old (median, 66) and the patients included 225 males and 52 females (Table 1). The clinical stage was stage I in 50 cases (18%), stage II in 53 cases (19%) and stage III in 174 cases (63%). Thirty-six patients received treatment in the 1970s, 66 patients in the 1980s, 72 patients in the 1990s and 103 patients in the 2000s (Table 1). The distribution of treatments according to the clinical stage is shown in Table 2.

There were a total of 277

Discussion

Two randomized prospective trials of surgery versus radiotherapy organized by the British Medical Research Council reported that surgery and radiotherapy were equally in effective for limited stage SCLC [15], [16]. According to these reports, fewer than 2% of patients survived more than two years after the resection. Later, in 1994, Lad et al. reported the results of a randomized trial evaluating the role of surgery in limited-stage SCLC conducted by the Lung Cancer Study Group [17]. This study

Conflict of interest

None.

References (25)

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    Another SEER-based study demonstrated that lobectomy was associated with a 5-year overall survival (OS) of greater than 50% for stage I SCLC.32 Another retrospective analysis of 277 patients with LS-SCLC also showed that surgical resection was associated with significantly improved 5-year survival compared with nonsurgical treatments (62% vs 25%; P=.01) in patients with stage I disease.33 A propensity score-matched pair analysis of patients with stage II or III disease showed improved 5-year survival with surgical resection (P=.04).

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