Propensity Score Matching Analysis for the Role of Surgery in Small Cell Lung Cancer

Wei, Shen; Wei, Bo; Tian, Jintao; Song, Xiaoping; Wu, Bingquan; Hu, Pengcheng

doi:10.1159/000506867

Cited by 7 publications

(7 citation statements)

References 27 publications

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“…Several previous studies suggested it was SCLC patients with early T and N stage who benefit more from surgical resection [ 16 , 17 ]. Wei and colleagues investigated the benefits of surgery.…”

Section: Discussionmentioning

confidence: 99%

“…Finding that the 5-year OS rate of patients underwent surgery was better compared to non-surgical patients (36.7% vs. 16.8%, p < 0.001). Yet the improvement of prognosis was less significant for T3 patients or patients with a tumor over 5.0 cm [ 17 ]. Gu and colleagues compared the prognosis between patients, who received comprehensive treatment, including surgery and chemoradiotherapy, and patients treated with only chemoradiotherapy.…”

Section: Discussionmentioning

confidence: 99%

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

Deng

et al. 2023

Eur J Med Res

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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.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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

Deng

et al. 2023

Eur J Med Res

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“…Of these, only manuscrpits dealing directly with surgical pulmonary resection in SCLC were selected. Based on these criteria, 14 publications were identified and included in the review [8][9][10][11][12][13][14][15][16][17][18][19][20][21](Tab. 1).…”

Section: Review Methodsmentioning

confidence: 99%

“…Even patients with mediastinal lymph nodes involvement, including N1-2 disease, can benefit from surgery. However, patients with tumour size >5.0 cm or advanced T stage may be unable to benefit from surgery [13]. This issue was also analyzed by Rucker et al in a study on the effect of lymph node assessment on outcomes in surgery for limited stage small cell lung cancer.…”

Section: Description Of the State Of Knowledgementioning

confidence: 99%

The role of pulmonary resection in early stage small cell lung cancer

Sagan¹,

Galek²,

Prystupa³

2021

J Pre Clin Clin Res.

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Introduction and Objective. For many decades, small-Cell Lung Cancer (SCLC) has been considered a non-surgical disease and is traditionally managed by chemo-and radiotherapy. However, recent advances in early detection of pulmonary lesions have made it possible to detect small cell lung cancer at a very early stage of development. The aim of this review was to assess the current state of knowledge on the role of surgical pulmonary resection in patients with early stage SCLC, and to determine the optimal diagnostic and therapeutic strategy for patients with pulmonary nodules suspected for SCLC. Review Methods. A literature search of the PubMed database was conducted using the key words: 'small cell lung cancer pulmonary resection not[non]' in the last 5 years. 99 manuscripts were found. Of these, only dealing directly with surgical pulmonary resection in SCLC were selected. Based on these criteria, 14 publications were identified and included in the review. Brief description of the state of knowledge. Current scientific and clinical data reveal that surgical resection offers patients with SCLC considerable therapeutic benefits with favourably high overall survival rates. Analyzed reports showed that the local relapse rate in patients after surgical resection was significantly lower than in the non-surgical group. Furthermore, definitive surgical resection with adjuvant chemotherapy resulted in improved survival for patients with early stage SCLC, when compared to conservative approach. Summary. Pulmonary resection of an early stage SCLC as a component of combined treatment offers considerable therapeutic benefits, among which almost 100% local control is of the greatest importance. Up-to-date clinical strategies strongly support the recommendation that peripheral pulmonary lesions suspected to be malign, should be surgically resected, unless serious contraindications are indicated.

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“…After adjustment for confounders using a Cox regression model, survival benefit of surgery was significant in all subgroups, including N1-2 disease, except for patients with a tumor size > 5.0 cm or T3 disease. The authors concluded that selected patients (T size <5 cm/T1-2) with SCLC would benefit from surgery, including N1-2 disease [104].…”

Section: Surgery Alone For Es-sclcmentioning

confidence: 99%

The current role of surgery and SBRT in early stage of small cell lung cancer

et al. 2021

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Background: Early stage small cell lung cancer (T1-2N0M0SCLC) represents 7% of all SCLC. The standard treatment in patients with intrathoracic SCLC disease is the use of concurrent chemoradiotherapy (CRT). Nowadays, the recommended management of this highly selected group is surgical resection due to favorable survival outcomes. For medically inoperable patients or those who refuse surgery, there is an increasing interest in evaluating the role of Stereotactic Body Radiotherapy (SBRT) for T1-2N0SCLC, transferring the favorable experience obtained on inoperable NSCLC (Non-Small-cell Lung Cancer). In the era of multimodality treatment, adjuvant systemic therapy plays an important role even in the management of early SCLC, increasing the disease-free survival (DFS) and Overall Survival (OS). The benefit of Prophylactic Cranial Irradiation (PCI), that currently has a Category I recommendation for localized stage SLCL, remains controversial in this selected subgroup of patients due to the lower risk of brain metastasis. Aim: This review summarizes the most relevant data on the local management of T1-2N0M0SCLC (surgery and radiotherapy), and evaluates the relevance of adjuvant treatment. Relevance for patients: Provides a critical evaluation of best current clinical management options for T1-2N0M0 SCLC.

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Propensity Score Matching Analysis for the Role of Surgery in Small Cell Lung Cancer

Cited by 7 publications

References 27 publications

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

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

The role of pulmonary resection in early stage small cell lung cancer

The current role of surgery and SBRT in early stage of small cell lung cancer

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