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

Zhang, Chenyue; Li, Cheng; Shang, Xiaoling; Lin, Jiamao

doi:10.3389/fonc.2019.01339

Cited by 14 publications

(11 citation statements)

References 34 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Our analyses focused on N2 disease; in these patients, surgery achieved longer OS than radiation and chemotherapy. In agreement with earlier studies [ 12 , 14 ], patients with T1 disease had longer survival than those with advanced T stage and also experienced a greater survival benefit from surgery, indicating that surgery is more effective in stage T1N2M0 SCLC.…”

Section: Discussionsupporting

confidence: 91%

“…In another investigation, the 5-year survival rate after surgery in patients with stage IIIA SCLC was 30.2%, which was higher than that in patients who had not undergone surgery [ 13 ]. Analyses of stage IIIA SCLC cases in the SEER database also demonstrated that surgery enhanced survival over chemoradiation [ 12 , 14 ]. However, the clinical benefit of surgery remains controversial; a retrospective study comparing the outcomes of SCLC patients following surgery and chemoradiation found similar survival rates for patients with stage IIIA disease [ 30 ].…”

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Effect of surgery on survival in patients with stage III N2 small cell lung cancer: propensity score matching analysis and nomogram development and validation

Chai

Feng

et al. 2021

World J Surg Onc

View full text Add to dashboard Cite

Background The standard treatment of stage III N2 small cell lung cancer (SCLC) is concurrent chemoradiation, and surgery is not recommended. This study was aimed to evaluate whether surgery has survival benefits in patients with stage III N2 SCLC and investigate the factors influencing survival of surgery. Methods Patients diagnosed with stage T1-4N2M0 SCLC from 2004 to 2015 were selected from the Surveillance Epidemiology End Results database. Propensity score matching (PSM) was used to balance confounders between patients who underwent surgery and those treated with radiation and/or chemotherapy. We compared overall survival (OS) of the two groups using Kaplan-Meier curves and a Cox proportional hazard model. We also identified prognostic factors in patients with surgical resection, and a nomogram was developed and validated for predicting postoperative OS. Results −A total of 5576 patients were included in the analysis; of these, 211 patients underwent surgery. PSM balanced the differences between the two groups. The median OS was longer in the surgery group than in the non-surgery group (20 vs. 15 months; p = 0.0024). Surgery was an independent prognostic factor for longer OS in the multivariate Cox regression analysis, and subgroup analysis revealed a higher survival rate in T1 stage patients treated with surgery (hazard ratio = 0.565, 95% confidence interval: 0.401–0.798; p = 0.001). In patients who underwent surgery, four prognostic factors, including age, T stage, number of positive lymph nodes, and radiation, were selected into nomogram development for predicting postoperative OS. C-index, decision curve analyses, integrated discrimination improvement, and time-dependent receiver operating characteristics showed better performance in nomogram than in the tumor-node-metastasis staging system. Calibration plots demonstrated good consistency between nomogram predicted survival and actual observed survival. The patients were stratified into three different risk groups by prognostic scores and Kaplan-Meier curves showed significant difference between these groups. Conclusions These results indicate that surgery can prolong survival in patients with operable stage III N2 SCLC, particularly those with T1 disease. A nomogram that includes age, T stage, number of positive lymph nodes, and radiation can be used to predict their long-term postoperative survival.

show abstract

Section: Discussionsupporting

confidence: 91%

Section: Discussionmentioning

confidence: 99%

Effect of surgery on survival in patients with stage III N2 small cell lung cancer: propensity score matching analysis and nomogram development and validation

Chai

Feng

et al. 2021

World J Surg Onc

View full text Add to dashboard Cite

show abstract

“…Patients with stage II SCLC require surgical treatment after an adequate preoperative evaluation, including mediastinoscopy (33). For patients with stage III SCLC, Zhang et al found that surgical treatment is associated with a better prognosis (7). In our study, the median survival time for stage III patients was 46 months, and a 5-year survival rate of 46.8%, which was better than that of stage II patients (20 months, 0%), although the difference was not statistically significant.…”

Section: Discussionmentioning

confidence: 99%

“…Systemic therapy, including chemotherapy, radiotherapy, and immunotherapy, has been widely accepted for the treatment of SCLC. Although the current National Comprehensive Cancer Network (NCCN) guidelines only recommend surgery for patients with clinical stages I-IIA SCLC (6), many studies have also found that patients with clinical stages II-III SCLC can also benefit from surgery (7)(8)(9)(10)(11)(12)(13). In addition, although more advanced diagnostic methods are now used for the diagnosis and classification of SCLC, the selection of surgical candidates for SCLC is still arbitrary.…”

Section: Introductionmentioning

confidence: 99%

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

Zeng¹,

Li²,

Li³

et al. 2021

Ann Transl Med

View full text Add to dashboard Cite

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.

show abstract

“…In the study of Yang et al [12], surgery brought a survival bene t to patients with stage IIB or stage IIIA SCLC. Zhang et al [13] suggested that surgery could improve the prognosis of patients with stage III SCLC. Xu et al [14] found that patients with stage IA, IB, IIA, III, or IV SCLC who received surgical treatment had a signi cantly prolonged survival time.…”

Section: Survival Analysismentioning

confidence: 99%

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

Chen¹,

Liu²,

Tian³

et al. 2020

Preprint

View full text Add to dashboard Cite

Background: Small-cell lung cancer (SCLC) patients are generally not considered to be candidates for surgical intervention. The role of surgery in the multidisciplinary treatment of SCLC remains controversial. The study aims to summarize and analyse the clinical characteristics and prognosis of SCLC patients after surgical treatment and identify the related prognostic factors.Methods: The clinical data of 130 SCLC patients (99 males and 31 females) who were treated by surgery and confirmed by postoperative pathological examination in Peking Union Medical College Hospital from April 2004 to April 2019 were analysed retrospectively.Results: The median age was 60 years (30-83 years), and the median disease duration was 2 months (0.5-48 months). The patients did not have specific clinical or imaging manifestations. Postoperative pathological examination revealed that 36 patients had stage I, 22 patients had stage II, 65 patients had stage III, and seven patients had stage IV SCLC. The median overall survival time was 50 months (95% confidence interval, 10.8-89.2 months). The median survival time of stage I, II, III, and IV SCLC patients were 148 months, 42 months, 32 months, and 10 months, respectively. In patients who underwent surgical treatment, postoperative adjuvant therapy and tumour stage were two significant influencing factors of survival (Cox multivariate analysis P < 0.05).Conclusions: Surgical treatment combined with adjuvant therapy can achieve satisfactory outcomes in selected SCLC patients. Adjuvant therapy and tumour stage are independent risk factors. Surgical treatment is indicated in SCLC patients preoperatively staged as I-IIIa, and anatomical lobectomy and lymphadenectomy combined with postoperative adjuvant therapy are recommended.

show abstract

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

Cited by 14 publications

References 34 publications

Effect of surgery on survival in patients with stage III N2 small cell lung cancer: propensity score matching analysis and nomogram development and validation

Effect of surgery on survival in patients with stage III N2 small cell lung cancer: propensity score matching analysis and nomogram development and validation

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

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

Contact Info

Product

Resources

About