Comparative study of clinicopathological characteristics and prognosis between combined and pure small cell lung cancer (SCLC) after surgical resection

Abstract

Background: Histologically, SCLC are classified as pure (P-SCLC) and combined subtypes (C-SCLC). Currently, few studies compare the clinicopathological characteristics and explore the treatment strategies applied to them. Methods: Between July 2005 and April 2016, the clinical records of 297 postoperative patients with pathologically confirmed SCLC were retrospectively analyzed. Kaplan-Meier method and Cox regression model were separately used for stratified univariate and multivariate survival analysis. Results: A total of 46 cases (15.5%) of C-SCLCs and 251 cases (85.5%) of pure SCLCs (P-SCLCs) were included in this study. The average age of C-SCLCs was a little higher than that of P-SCLCs (59.65 AE 8.72 vs. 56.56 AE 10.12; P = 0.053). More patients had a history of smoking in C-SCLC (78.3% vs. 63.3%; P = 0.074). The five-year overall survival (OS) rate for P-SCLCs and C-SCLCs was 65.1% and 56.7%, respectively (P = 0.683). For P-SCLC, stage and an intervention of prophylactic cranial irradiation (PCI) were independent factors that affected OS. In C-SCLCs cases, performing sublobectomy was an independent risk factor for poor prognosis. Conclusions: We identified no significant difference in clinical characteristics and outcome between C-SCLCs and P-SCLCs. However, the factors affecting the prognosis of the two subtypes were slightly inconsistent. For C-SCLCs, the extent of resection had a greater impact on survival, and lobectomy combined with systemic lymph node dissection should therefore be performed as extensively as possible. In addition, PCI was beneficial in improving the SCLC OS rate. Key points • This study demonstrated the prognosis of C-SCLCs did not significantly differ from that of P-SCLCs, but was more susceptible to the extent of resection. Patients with C-SCLC who underwent limited resection had a significantly increased risk of shorter OS. • This study highlighted the importance of performing lobectomy for resectable C-SCLC patients. This study also proved the benefit of PCI in improving the OS rate for both P-SCLC and C-SCLC patients.

Comprehensive analysis of prognostic predictors for patients with limited-stage small-cell lung cancer who underwent resection followed by adjuvant chemotherapy

“…However, our figure was obviously larger than the figure of 28% found in a previous study (4). Notably, there were no statistical differences in relation to the clinical characteristics of the p-SCLC and c-SCLC groups, which supports the findings of Guo's and Zhang's previous research (13,14). In relation to the survival outcomes, Zhang's research revealed that c-SCLC patients had a worse OS rate than that of p-SCLC patients (14).…”

Construction and Validation of a Novel Nomogram to Predict the Overall Survival of Patients With Combined Small Cell Lung Cancer: A Surveillance, Epidemiology, and End Results Population-Based Study

“…Nevertheless, we found that patients can benefit from surgery and chemotherapy. Previous studies had proposed some factors that were potentially correlated with OS of C-SCLC, including smoking history, 10 extensive-stage disease, 11 lymph node metastasis, 2 , 8 adjuvant treatment, 2 , 10 , 11 and pathologically combined LCNEC 10 and SCC. 17 Lei et al reported that lymph node metastasis was significantly correlated with decreased disease-free survival (DFS) and OS in surgically resected C-SCLC, consistent with our finding.…”

YAP1 protein expression has variant prognostic significance in small cell lung cancer (SCLC) stratified by histological subtypes

“…[5][6][7] Previous studies have shown that the clinical characteristics of C-SCLC do not differ significantly from those in patients with P-SCLC. [5,7,8] In addition, C-SCLCs have been treated based on SCLC guidelines, [9] similarly with a platinum agent and etoposide with or without thoracic radiation, after adjustments for tumor extent or stage for over three decades. [10] Therefore, to date, SCLC has been regarded as a 'homogenous' disease with little documented inter-tumor heterogeneity with respect to histology or molecular biology in clinical practice.…”