Excellent survival of pathological N0 small cell lung cancer patients following surgery

Abstract

Background Current clinical guidelines recommend surgery only for cT1-2N0M0 small cell lung cancer (SCLC) patients. In light of recent studies, the role of surgery in the treatment of SCLC needs to be reconsidered. Methods We reviewed all SCLC patients who underwent surgery from November 2006 to April 2021. Clinicopathological characteristics were retrospectively collected from medical records. Survival analysis was performed by the Kaplan–Meier method. Independent prognostic factors were evaluated by Cox proportional hazard model. Results 196 SCLC patients undergoing surgical resection were enrolled. The 5-year overall survival for the entire cohort was 49.0% (95% CI: 40.1–58.5%). PN0 patients had significantly superior survival to pN1–2 patients (p < 0.001). The 5-year survival rate of pN0 and pN1–2 patients were 65.5% (95% CI: 54.0–80.8%) and 35.1% (95% CI: 23.3–46.6%), respectively. Multivariate analysis revealed that smoking, older age, and advanced pathological T and N stages were independently associated with poor prognosis. Subgroup analyses demonstrated similar survival among pN0 SCLC patients regardless of pathological T stages (p = 0.416). Furthermore, multivariate analysis showed factors, including age, smoking history, type of surgery, and range of resection, were not independently prognostic factors for the pN0 SCLC patients. Conclusion Pathological N0 stage SCLC patients have significantly superior survival to pN1–2 patients, regardless of features, including T stage. Thorough preoperative evaluation should be applied to estimate the status of lymph node involvement to achieve better selection of patients who might be candidate for surgery. Studies with larger cohort might help verify the benefit of surgery, especially for T3/4 patients.

Prolonged Survival in a Patient With Extensive-Stage Small Cell Lung Cancer in Spite of Discontinued Immunotherapy With Atezolizumab

“…His clinical course is worth noting, considering that ES-SCLC patients typically have a poor prognosis with a median survival of 10 months and a five-year survival rate of less than 2% [10,11]. Classical features proposed as favorable outcome characteristics in SCLC include disease in earlier stages and a good response to initial therapy [12].…”

Lymph node metastasis in cancer progression: molecular mechanisms, clinical significance and therapeutic interventions

“… 157 Nodal status is among the most reliable prognostic indicators in lung cancer patients, making it vital to the selection of optimal therapeutic approaches. 158 , 159 The International Association for the Study of Lung Cancer (IASLC) established an LN map in 2009 that provides detailed anatomic definitions for all LN stations (numbered 1–14), which are grouped into the supraclavicular, upper, aortopulmonary (AP), subcarinal, lower, hilar/interlobar, and peripheral zones, enabling more reliable analyses of the association between these nodes and survival outcomes (Fig. 5 ).…”