Clinical outcomes of surgically resected combined small cell lung cancer: a two-institutional experience

Zhang, Chao; Yang, Haitang; Zhao, Heng; Lang, Baoping; Yu, Xiaoyan; Pan, Xiao; Zhang, Xiao

doi:10.21037/jtd.2017.01.07

Cited by 32 publications

(37 citation statements)

References 28 publications

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“…SCLC comprises approximately 13% of all lung cancers . The incidence of C‐SCLC varies from 5% to 28% depending on the specimen used . Although recent advances in diagnostic techniques have resulted in a reported increase in the incidence of C‐SCLC, the clinicopathologic features, appropriate treatment, and prognosis of C‐SCLC remain poorly elucidated.…”

Section: Introductionmentioning

confidence: 99%

“…Although recent advances in diagnostic techniques have resulted in a reported increase in the incidence of C‐SCLC, the clinicopathologic features, appropriate treatment, and prognosis of C‐SCLC remain poorly elucidated. Several retrospective studies have reported that C‐SCLC has quite characteristic clinical features, including male predominance, peripheral location in half of C‐SCLCs, more limited stages in 70%, and stage I or II in only 3% . These characteristics explain the possible benefit of multimodality therapies, including surgery, in patients with C‐SCLC.…”

Section: Introductionmentioning

confidence: 99%

“…6 The incidence of C-SCLC varies from 5% to 28% depending on the specimen used. 7,8 Although recent advances in diagnostic techniques have resulted in a reported increase in the incidence of C-SCLC, the clinicopathologic features, appropriate treatment, and prognosis of C-SCLC remain poorly elucidated. Several retrospective studies have reported that C-SCLC has quite characteristic clinical features, including male predominance, peripheral location in half of C-SCLCs, more limited stages in 70%, and stage I or II in only 3%.…”

Section: Introductionmentioning

confidence: 99%

“…Several retrospective studies have reported that C-SCLC has quite characteristic clinical features, including male predominance, peripheral location in half of C-SCLCs, more limited stages in 70%, and stage I or II in only 3%. 8 These characteristics explain the possible benefit of multimodality therapies, including surgery, in patients with C-SCLC. Treatment for C-SCLC currently follows SCLC guidelines, but the optimal treatment remains unclear.…”

Section: Introductionmentioning

confidence: 99%

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Effect of histological subtype and treatment modalities on T1–2 N0–1 small cell lung cancer: A population‐based study

et al. 2019

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Background Combined small cell lung cancer (C‐SCLC) is rare and its clinical features, appropriate treatment, and prognosis are poorly understood. Reports conflict over the prognosis of C‐SCLCs compared to pure small cell lung cancer. Methods The records of patients diagnosed with primary SCLC from 1988 to 2014 were extracted from the Surveillance, Epidemiology, and End Results database. The general features of C‐SCLCs were compared to those of SCLCs. T1–2 N0–1 data was extracted and the effects of the histological subtype, treatment modality, and other prognostic factors on lung cancer‐specific survival (CSS) was analyzed in a 3:1 matched dataset. Analysis was performed using the 8th edition tumor node metastasis staging system and previous staging systems adjunctively. Results C‐SCLCs comprised 1.5% of all SCLCs (1486/98 667); 184 cases of C‐SCLCs and 2681 cases of non‐combined SCLCs (NC‐SCLCs) were included in this study. C‐SCLCs were more likely to be of a higher grade and to occur in the upper lobe than NC‐SCLCs. Before matching, C‐SCLCs showed better CSS (hazard ratio 0.69; P < 0.001). However, stratified Cox proportional hazards analysis in the matched dataset revealed that only treatment modality and age at diagnosis were associated with CSS; the histological subtype had no effect on survival. Of all treatment modalities, surgery with chemoradiation showed the best CSS in T1–2 N0–1 SCLC. Conclusion In early SCLC, surgery with chemoradiation shows the best CSS. C‐SCLC patients might benefit more from multimodal treatments, including surgery, than SCLC patients.

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Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Effect of histological subtype and treatment modalities on T1–2 N0–1 small cell lung cancer: A population‐based study

et al. 2019

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“… 21 Similarly, Zhang et al reported combined histology in 30.4% of surgically resected specimens of SCLC patients. 22 …”

Section: Discussionmentioning

confidence: 99%

Non-small cell to small cell lung cancer on PD-1 inhibitors: two cases on potential histologic transformation

Abdallah

Nagasaka

Abdulfatah

et al. 2018

LCTT

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IntroductionHistologic transformation from non-small cell lung cancer (NSCLC) to small cell lung cancer (SCLC) is a well-recognized mechanism of resistance in EGFR-mutant adenocarcinoma upon treatment with TKIs, but rarely reported with programmed death1 (PD-1) inhibitors. We report two cases of potential transformation during treatment with PD-1 inhibitors.Case presentationsCase 1, a 65-year-old man was diagnosed with stage IVa lung adenocarcinoma on pleural fluid cytology. He received six cycles of carboplatin and pemetrexed, then maintained on pemetrexed. He had disease progression after nine cycles of pemetrexed and was switched to nivolumab. He progressed after five cycles of nivolumab. Core biopsy of the lung mass revealed SCLC. Case 2, a 68-year-old man was diagnosed with two primary NSCLCs and underwent resection. He had recurrence after several months and was treated with four cycles of carboplatin, paclitaxel, and pembrolizumab on clinical trial, with partial response. He was continued on pembrolizumab and had disease progression after 30 cycles. Biopsy of the new lesions showed SCLC.DiscussionHistologic transformation from NSCLC to SCLC can be explained by the presence of a common cell precursor. Proposed molecular mechanisms include loss of RB1, TP53 mutations, and MYC amplification. The distinction between transformation and mixed histology tumors is challenging, especially when pathologic material used for the initial diagnosis is limited. The possibility of a second metachronous primary lung cancer cannot be excluded in our cases.ConclusionHistologic transformation with PD-1 inhibitors could be under-recognized. Disease progression should prompt re-biopsy to uncover new histology and change in treatment. Future studies are needed to elucidate mechanisms and predictors of transformation.

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

Yang

Yao

et al. 2018

J Cancer Res Clin Oncol

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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.

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Clinical outcomes of surgically resected combined small cell lung cancer: a two-institutional experience

Abstract: The mixed NSCLC components within c-SCLCs had a significant influence on the survival. Compared with surgery alone, adjuvant therapy was associated with significantly improved survival in patients with complete resection and lymphadenectomy.

Cited by 32 publications

References 28 publications

Effect of histological subtype and treatment modalities on T1–2 N0–1 small cell lung cancer: A population‐based study

Effect of histological subtype and treatment modalities on T1–2 N0–1 small cell lung cancer: A population‐based study

Non-small cell to small cell lung cancer on PD-1 inhibitors: two cases on potential histologic transformation

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

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