Prognosis of limited-stage small cell lung cancer with comprehensive treatment including radical resection

Abstract

Background: The NCCN (National Comprehensive Cancer Network) Clinical Practice Guidelines in Oncology (NCCN guidelines) recommend radical resection for T1-2N0M0 patients with limited-stage small cell lung cancer (LS-SCLC). However, only about 5% of patients with small cell cancer (SCLC) were initially diagnosed as T1-2N0M0. The purpose of our study was to analyze and compare the effects of the comprehensive treatment including radical surgery and concurrent chemoradiotherapy on the prognosis of patients with LS-SCLC. Methods: We comprehensively reviewed the medical data of patients with SCLC diagnosed by pathology in our hospital from January 2011 to April 2018. The Ethics Committee of West China Hospital of Sichuan University approved the study. Finally, 50 patients with good follow-up and complete medical data were selected as the surgical group (S group). According to the clinical characteristics of the patients in the S group, 102 LS-SCLC patients who received concurrent chemoradiotherapy in the same period were included in the CCRT group (concurrent chemoradiotherapy group) as the control group. Then according to the orders of the adjuvant treatments, the patients in the S group were divided into the SA group (radical surgery + adjuvant chemotherapy + adjuvant radiotherapy group, 30 cases in total) and the NS group (neoadjuvant chemotherapy + radical surgery + adjuvant chemotherapy ± adjuvant radiotherapy group, 20 cases in total) for subgroup analysis. The SPSS 23.0 software was used for statistical analysis, and the t test was used for group comparison; Kaplan-Meier was used for survival analysis. P < 0.05 demonstrates a statistically significant difference. Results: The median progress-free survival (PFS) in the S group (73 months) was significantly better than that in the CCRT group (10.5 months, P < 0.0001), and the median overall survival (OS) in the S group (79 months) was also significantly better than that in the CCRT group (23 months, P < 0.0001). Subgroup analysis showed that there was no significant difference between the NS group and the SA group. Conclusions: For LS-SCLC patients, the comprehensive treatment including radical surgery (radical surgery + adjuvant chemotherapy ± adjuvant radiotherapy/neoadjuvant chemotherapy + radical surgery + adjuvant chemotherapy ± adjuvant radiotherapy)may be superior to concurrent chemoradiotherapy.

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

“…4d, Table 2, univariate survival analysis P = 0.019, multivariate analysis P = 0.014). Zhong et al [34] reported that preoperative neoadjuvant radiochemotherapy did not improve the prognosis of patients who were surgically treated for SCLC, and our study did not nd any prognostic bene t of neoadjuvant therapy (P = 0.39). However, because this study is a retrospective study with a long time span, the chemotherapy and radiotherapy regimens and the implementation standards of neoadjuvant therapy for patients were inconsistent throughout the study period.…”

Prognostic factors of patients with small cell lung cancer after surgical treatment

“…These are the main reasons why smoking affects postoperative complications (22)(23)(24). Some studies have shown that neoadjuvant chemotherapy combined with surgery can improve the prognosis of SCLC patients, as neoadjuvant chemotherapy may reduce the T or N stage of the tumor, thereby reducing the risk of death (25)(26)(27). Among patients with nodal metastases, only those with negative nodes following induction chemo/ chemoradiotherapy should be candidates for surgery (15).…”

The Prognostic Value of Sex-Determining Region Y-Box 2 and CD8+ Tumor-Infiltrating Lymphocytes in Limited-Stage Small-Cell Lung Cancer

“…Compared to the homogeneous platinum based systemic chemotherapy approach in ES-SCLC, LS-SCLC is treated with varied treatment modalities based on clinical characteristics such as the lung function and TNM stage. Recently, surgical resection and concurrent chemoradiotherapy are recommended for LS-SCLC with T1-2N0M0 [35]. Moreover, the study for the radiotherapy schedule, radiation dose, and the candidate for prophylactic cranial irradiation has been continuously conducted to improve the prognosis of patients with LS-SCLC [36, 37].…”