Survival Outcomes for Patients with Surgical and Non-Surgical Treatments in Stages I-III Small-Cell Lung Cancer

Che, Keying; Shen, Hongchang; Qu, Xiao; Pang, Zhaofei; Jiang, Yuanliang; Liu, Shaorui; Yang, Xudong; Du, Jingchun

doi:10.7150/jca.23583

Cited by 27 publications

(33 citation statements)

References 35 publications

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“…The NCCN guidelines version 2 (2018) suggest that patients with SCLC at a stage higher than T1-2 with N0 do not benefit from surgery 6 . However, reports show that surgery can Ivyspring International Publisher significantly improve survival outcomes in SCLC patients and should be considered in the management of SCLC at stages higher than T1-2 with N0 7 .…”

Section: Introductionmentioning

confidence: 99%

Benefits of surgery in the multimodality treatment of stage IIB-IIIC small cell lung cancer

Yang¹,

Yuan²,

Zhan³

et al. 2019

J. Cancer

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Surgery combined with chemotherapy/radiotherapy is recommended for early stage small cell lung cancer (SCLC); however, the role of surgery in the multimodality treatment of advanced disease remains controversial. The clinical data of patients between 2000 and 2015 were obtained from the Surveillance, Epidemiology, and End Results database. The surgery group included 998 patients with stage IIB-IIIC. A matched non-surgery group (n = 2994) was generated by propensity score matching. The Kaplan-Meier method and log-rank tests were used for survival analyses. Univariate and multivariate analyses were used to identify significant prognostic factors. After matching, there were no significant differences between the two groups in race, age, sex, T classification, N classification, TNM stage, marital status, primary sites, and origin record NAACCR Hispanic Identification Algorithm (NHIA). The surgery group showed better overall survival and cancer-specific survival than the non-surgery group. Univariate and multivariate analyses showed that therapy methods, age, sex, T classification, and N classification were independent prognostic predictors for stage IIB-IIIC SCLC (all P < 0.05). Stratified analyses showed that survival outcomes favored surgery in any age groups, men and women, any T classification except T3, and N0-2 but not N3 compared with non-surgical treatment. The survival differences favored surgery in stage IIB and IIIA SCLC, although they were not significant in stage IIB and IIIC SCLC. Therefore, surgery was associated with improved survival in stage IIB and IIIA SCLC, but not in stage IIIB and IIIC SCLC.

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Section: Introductionmentioning

confidence: 99%

Benefits of surgery in the multimodality treatment of stage IIB-IIIC small cell lung cancer

Yang¹,

Yuan²,

Zhan³

et al. 2019

J. Cancer

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“…We divided the 15 articles into 21 studies because 5 articles were straight stratified according to surgical treatment type or clinical stage [14, 19, 21, 30–31]. HRs were extracted directly for 7 out of 15 studies [11, 14–17, 20–21], and calculated using the Kaplan-Meier curve for the remaining. Significant statistical difference was observed between the surgery and NST groups in a pooled analysis of OS for 41,297 patients from retrospective studies (HR = 0.56, 95% CI: 0.49–0.64, P < 0.001) (Fig 2A), but not for 186 patients from RCTs (HR = 0.77, 95% CI: 0.32–1.84, P = 0.55) (Fig 2B).…”

Section: Resultsmentioning

confidence: 99%

“…However, these RCTs were performed more than 2 decades ago, which from today’s perspective, did not fulfil modern quality requirements. Recent data from numerous retrospective studies, including some large retrospective cohort studies, have demonstrated a potential survival benefit from surgery in patients with limited disease [11–21]. In light of these findings, we carried out a systematic review and meta-analysis of the currently available evidences to further determine whether surgery-based multi-modality treatment improves survival when compared to RT, chemotherapy, or a combination of both in patients with stage I to III SCLC.…”

Section: Introductionmentioning

confidence: 99%

The role of surgery in stage I to III small cell lung cancer: A systematic review and meta-analysis

et al. 2018

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BackgroundThe role of surgery in treating small cell lung cancer (SCLC) remains controversial. This meta-analysis aims to determine whether surgical-based treatment improves survival in comparison to radiotherapy, chemotherapy, and chemoradiotherapy for stage I to III SCLC.MethodsPubMed, PubMed Central, EMBASE, Web of Science, and Cochrane Library were searched for relevant articles. The main outcome were overall survival (OS), reported as hazard ratios (HRs), and 95% confidence intervals (CIs).ResultsTwo randomized control trials (RCTs) and 13 retrospective studies that included a total of 41,483 patients were eligible. Surgical resection significantly improved OS when compared to non-surgical treatment in retrospective studies (HR = 0.56, 95% CI: 0.49–0.64, P < 0.001), but not in the 2 “older” RCTs (HR = 0.77, 95% CI: 0.32–1.84, P = 0.55). In the subgroup analysis for retrospective studies, surgical resection was associated with superior OS in stage I (HR = 0.56, 95% CI: 0.49–0.64, P < 0.001), stage II (HR = 0.75, 95% CI: 0.57–0.99, P = 0.04), and stage III diseases (HR = 0.70, 95% CI: 0.56–0.88, P = 0.002). Sublobar resection resulted in worse OS than a lobectomy (HR = 0.64, 95% CI: 0.56–0.74, P < 0.001) for patients undergoing surgical resection.ConclusionsSurgery-based multi-modality treatment appears to be associated with a favorable survival advantage in stage I and selected stage II to III SCLC. Lobectomy is likely to provide superior OS when compared to sublobar resection. Further prospective RCTs are needed to confirm these findings.

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“…When the two had different opinions, the third radiologist reviewed them. The TNM staging criteria for patients were based on the Union for International Cancer Control/American Joint Committee on Cancer (UICC/AJCC) 8th Edition (34,35). The inclusion criteria were: 1) 18-75 years old and KPS score ≥ 70; 2) lung cancer diagnosed by histopathology; 3) no EGFR/ALK mutations; 4) if EGFR/ALK mutation, patients must have received EGFR/ALK-TKIs as rst-line treatment, and exhibited resistance or intolerance; 5) received at least two chemotherapy regimens or intolerance, 6) BM was diagnosed by computed tomography/magnetic resonance imaging (CT/MRI); 7) patients received CRT and anlotinib concurrent treatment, or CRT treatment alone (Fig.…”

Section: Patientsmentioning

confidence: 99%

Therapeutic effect of cranial radiotherapy with or without anlotinib treatment for lung cancer patients with brain metastasis and non-EGFR/ALK-TKIs indication

Liu

et al. 2020

Preprint

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Background: Cranial radiotherapy (CRT) is the main treatment for lung malignant tumor with brain metastasis (BM) and lacking EGFR/ALK-TKIs indication. For non-small cell lung cancer with BM, anlotinib can improve progression free survival (PFS). We retrospectively analyzed the clinical effects of anlotinib + CRT versus CRT alone.Methods: In patients with lung cancer (adenocarcinoma, squamous carcinoma, or small cell carcinoma) with BM and non-EGFR/ALK-TKIs indication, the overall survival (OS) and PFS of anlotinib + CRT treatment versus CRT treatment alone were separately calculated and compared. The Cox proportional hazards model was used to analyze the independent prognostic factors for intracranial PFS (iPFS) and OS. All confounding factors were adjusted, including age, gender, Karnofsky Performance Status (KPS) score, smoking history, physiological characteristics, T/N stage, histology, metastases, and pathological characteristics. Subgroup analysis for iPFS and OS was performed to assess the effects on BM of treatment pattern.Results: The study included 100 patients with BM at baseline and the follow-up data. Of the 100 patients, 67 patients received CRT treatment alone and 33 patients received CRT + anlotinib treatment. The overall response rates of the CRT + anlotinib group and the CRT alone group were 90.91% and 83.58%, respectively. There was significantly more iPFS in the CRT + anlotinib group compared to CRT alone (median iPFS [miPFS]: 9.0 vs 3.0 months; hazard ratio [HR] 1.59; 95% confidence interval [CI] 1.01-2.52; p = 0.038). The OS, extracranial PFS (ePFS), and systematic PFS (sPFS) of CRT + anlotinib group were longer than those of the CRT alone group, but there was no significant statistical difference (median OS [mOS]: 9.0 vs 7.0 months, HR 1.17, 95% CI 0.74-1.85; median ePFS [mePFS]: 9.0 vs 7.0 months, HR 1.23, 95% CI 0.72-2.11; median sPFS [msPFS]: 7.0 vs 4.0 months, HR 1.37, 95% CI 0.82-2.30). The Cox proportional hazards model analysis revealed that age was an independent prognostic factor of iPFS (HR 1.65, 95% CI 1.05-2.59, p = 0.03). Age (HR 1.74, 95% CI 1.09-2.77, p = 0.02) and KPS score (HR 1.88, 95% CI 1.17-3.01, p = 0.01) were identified as independent prognostic factors of OS. Further subgroup analysis of iPFS showed that when the number of BM in the CRT + anlotinib group was less than or equal to three lesions (≤ 3), the miPFS (12.0 months) was significantly longer than that for CRT alone (> 3) (3.0 months), for CRT alone (≤ 3) (3.0 months), and for CRT + anlotinib (> 3) (7.0 months) (p = 0.014). The OS of the CRT + anlotinib group (≤ 3) (mOS 37.0 months) was much longer than that in CRT alone (> 3) (mOS 6.0 months), CRT alone (≤ 3) (mOS 7.5 months), and CRT + anlotinib (> 3) (mOS 8.5 months) groups, but this difference was not statistically significant (p = 0.051).Conclusion: Anlotinib can improve the survival of patients with lung cancer BM, with better efficacy of a combined treatment of anlotinib + CRT compared to that of CRT alone, especially for the iPFS of patients with BM ≤ 3.

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Survival Outcomes for Patients with Surgical and Non-Surgical Treatments in Stages I-III Small-Cell Lung Cancer

Cited by 27 publications

References 35 publications

Benefits of surgery in the multimodality treatment of stage IIB-IIIC small cell lung cancer

Benefits of surgery in the multimodality treatment of stage IIB-IIIC small cell lung cancer

The role of surgery in stage I to III small cell lung cancer: A systematic review and meta-analysis

Therapeutic effect of cranial radiotherapy with or without anlotinib treatment for lung cancer patients with brain metastasis and non-EGFR/ALK-TKIs indication

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