Analysis of unexpected small cell lung cancer following surgery as the primary treatment

Abstract

Purpose Small cell lung cancer (SCLC) is considered a systemic disease and surgery is generally not recommended to treat it. High heterogeneity within the tumor and preoperative diagnostic capabilities can sometimes fail to identify SCLC correctly, leading to a subset of unexpected SCLC patients that are diagnosed only after pulmonary resections. Methods We retrospectively reviewed the clinical records of patients who were diagnosed as having SCLC only after surgery between 2008 and 2015 at a single institution. Results A total of 125 unexpected SCLC patients were identified, including those with pure (p-SCLC; n = 76, 60.8%) and combined (c-SCLC; n = 49, 39.2%) SCLC. Highly differential diagnoses were observed between pre-and postoperative tissue examinations. Sixty-nine (55.2%) patients with postoperatively pathological-proven SCLC, including 31 with p-SCLC and 38 with c-SCLC, were diagnosed preoperatively with poorly differentiated carcinoma (n = 23), squamous carcinoma (n = 14), adenocarcinoma (n = 10), malignant cells with necrosis (n = 10), large cell carcinoma (n = 8), or carcinoid (n = 4). Also, inconsistencies between the clinical (c-) and pathological (p-) stages were found in this cohort, which were less common in patients with preoperative PET examination than those without (24.4% vs. 43.8%; p = 0.032). Multivariable analyses showed that higher p-stage (hazards ratio (HR) = 1.7349, p = 0.0025), sub-lobar resection (HR = 1.9078, p = 0.0395), and a lack of prophylactic cranial irradiation treatment (PCI, HR = 0.3873, p = 0.0057) were unfavorable prognostic factors for overall survival. Conclusion Non-resection approaches reveal an inadequate diagnosis of SCLC. PET examination facilitates the evaluation of the clinical staging of SCLC. For unexpected SCLC undergoing resection, favorable outcomes can be achieved if radical resection and postoperative PCI are performed.

Preoperative peripheral blood neutrophil-to-lymphocyte ratios (NLR) and platelet-to-lymphocyte ratio (PLR) related nomograms predict the survival of patients with limited-stage small-cell lung cancer

“…The data in this study were based on our previous studies of patients with surgically resected SCLC (23)(24)(25).…”

Surgery as a Potential Treatment Option for Patients With Stage III Small-Cell Lung Cancer: A Propensity Score Matching Analysis

“…Recently, several reports on the successful treatment of SCLC using surgical resection have been published (28, 29). However, due to lack of a control group and a relatively small sample size, the results have been considered less convincing.…”

Clinical Outcomes and Prognosis of Small-Cell Lung Cancer(SCLC) Patients After Surgery: a Single-Centre Retrospective Cohort Study from Peking Union Medical College Hospital

“…In the study of Liu et al [21], the rate of subpulmonary lobectomy in stage I patients reached 31%; neither this study nor previous studies found that subpulmonary lobectomy did not bring a survival bene t to stage I patients [22]. A portion of studies stated that lobectomy led to a more satisfactory prognosis than subpulmonary lobectomy [21,23,24], and the prognosis after lobectomy and subpulmonary lobectomy was superior to that after pneumonectomy [25]. In the present study, the patients underwent subpulmonary lobectomy, lobectomy, or compound lobectomy (including pneumonectomy), and the survival curve showed that the prognosis after subpulmonary lobectomy was worse (Fig.…”