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

Abstract

Background: The current National Comprehensive Cancer Network guidelines recommend surgical treatment for patients with stages I-IIA small cell lung cancer (SCLC), but it still cannot deny the effect of surgical treatment on other limited-stage SCLC. Although more advanced diagnostic methods are now used for the diagnosis and classification of SCLC, the selection of surgical candidates is still arbitrary.Methods: Data were collected from patients with SCLC who underwent surgery at the First Affiliated Hospital of Zhengzhou University from January 2011 to January 2021. Kaplan-Meier method was used to calculate cumulative survival curves, and log-rank test was used to evaluate differences among different subgroups. The Cox proportional hazard regression model was used to assess the predictive power of the variables for prognosis and survival. Results: Smoking index, surgical resection method, TNM stage of postoperative pathology, and postoperative chemotherapy were significantly correlated with postoperative survival (P<0.05), which were independent predictors for postoperative survival. Patients with a smoking index >800 had a higher risk of death after surgery [hazard ratio (HR): 7.050, 95% confidence interval (CI): 3.079-16.143, P<0.001]. Compared with patients who underwent pulmonary lobectomy, those who underwent other pneumoresections (e.g., wedge resection, segmental resection, sleeve resection) had an increased risk of death (HR: 2.822, 95% CI: 1.030-7.734, P=0.044). Compared with stage I patients, stage II and stage III patients had an increased risk of death, with HRs of 6.039 and 3.145, respectively. Compared with those who received ≤4 courses of postoperative chemotherapy, those who received >4 courses of postoperative chemotherapy had reduced postoperative mortality risk (HR: 0.211, 95% CI: 0.097-0.459, P<0.001). Conclusions: A high smoking index suggests worse prognosis; therefore, patients who smoke should be advised to quit smoking. Compared with stage II and stage III patients, surgical treatment is recommended for stage I SCLC patients. TNM staging, especially N staging, should be evaluated prior to surgery. Pulmonary lobectomy with mediastinal lymph node dissection should be the preferred surgical treatment for patients with SCLC. Patients should receive at least 5 courses of adjuvant chemotherapy after surgery.

Construction and validation of a nomogram based on the log odds of positive lymph nodes to predict cancer-specific survival in patients with small cell lung cancer after surgery

“…Nevertheless, there were some limitations in the present study. First, smoking index has been shown to be an independent prognostic factor and has been incorporated into some nomograms to predict survival [ 42 ]. However, the present study database lacked data related to smoking.…”

Dynamics of a diffusive model for cancer stem cells with time delay in microRNA-differentiated cancer cell interactions and radiotherapy effects

“…In fact, between 6 and 24 months after the primary tumor, 52.3 percents of triple-negative metastases are discovered, 24 percents of metastases are discovered for HER2+ and 12 percent of metastases are discovered for HR+HER2- 46 . For a lung cancer is less than 2 years and this time corresponds to an early recurrence observed in small cell lung cancer 47 , 48 . For a prostate cancer .…”

A 15-Gene-Based Risk Signature for Predicting Overall Survival in SCLC Patients Who Have Undergone Surgical Resection

“…Although current American Society of Clinical Oncology and European Society for Medical Oncology guidelines indicate that surgical resection should be considered only in patients with stage I SCLC [35,36], curative surgery may be preferred as part of comprehensive treatment in both early and advanced SCLC patients [5]. However, the survival benefit of surgery in SCLC is still controversial [37,38], and the selection of surgical candidates for SCLC is still arbitrary [39]. Therefore, there is a need to elucidate the molecular etiology of the disease to suggest more effective treatment strategies and to identify new diagnostic and predictive biomarkers that aid clinical decision-making.…”

“…The parameters associated with survival outcomes of patients with resected SCLC vary between studies. Relevant factors that may indicate the prognosis of surgery for the clinical treatment of SCLC and the selection of candidates for surgery have previously been reported as smoking index, method of surgical resection, TNM stage of postoperative pathology, and postoperative chemotherapy [39,54]. In the Surveillance, Epidemiology, and End Results (SEER) Survey from 2010 to 2015, among the age, race, sex, stage, primary site, histologic type, chemotherapy and radiation parameters, only age, stage, and chemotherapy have been reported to be associated with survival in patients with resected SCLC [5].…”