Redefining the role of surgery in early small-cell lung cancer

Doerr, Fabian; Stange, Sebastian; Michel, Maximilian; Schlachtenberger, Georg; Menghesha, Hruy; Wahlers, Thorsten; Hekmat, Khosro; Heldwein, M.

doi:10.1007/s00423-022-02631-4

Cited by 5 publications

(5 citation statements)

References 43 publications

(75 reference statements)

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“…For a long time, lobectomy is the standard surgical procedure for stage I NSCLC ( 25 ). In recent years, some evidence has shown that segmentectomy has better outcomes than lobectomy in stage IA1-2 (T1a-bN0M0) NSCLC ( 4 – 6 ).…”

Section: Discussionmentioning

confidence: 99%

Lobectomy versus segmentectomy for stage IA3 (T1cN0M0) non-small cell lung cancer: a meta-analysis and systematic review

Zhang,

Chen,

Lin

et al. 2023

Front. Oncol.

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BackgroundSegmentectomy has been proven to have better survival and perioperative efficacy than lobectomy for non-small cell lung cancer (NSCLC) up to 2 cm. Whether this result is applicable to stage T1cN0M0 NSCLC (2.1 to 3 cm) remains controversial.MethodsWe conducted a comprehensive search across seven databases to identify relevant studies comparing lobectomy and segmentectomy procedures. Our primary focus was on survival indicators (overall survival [OS] and disease-free survival [DFS]), while for secondary outcomes, operative outcomes, hospitalization outcomes, recurrences, and complications were considered.ResultsAfter screening, the final analysis included 10 studies (involving 22113 patients in the lobectomy group and 1627 patients in the segmentectomy group). The lobectomy procedure achieved better OS (hazard ratio [HR]: 1.19 [1.07~1.33]) and DFS (HR: 1.37 [1.10~1.71]), which were proven in all subgroups. The OS rate at 2-5 years and DFS rate at 4-5 years were higher in the lobectomy group. The advantages of OS and DFS in the lobectomy group increased over the survival time. More lymph node dissections, intraoperative blood loss and total complications were found in the lobectomy group. Similar hospital stays, 90-day mortality and conversion thoracotomy were found between the two groups.ConclusionLobectomy appeared to be the better choice for patients with stage T1cN0M0 NSCLC with better survival (OS and DFS). However, the complications needed to be taken seriously.Systematic review registrationhttps://www.crd.york.ac.uk/PROSPERO/, identification CRD42023445013.

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Section: Discussionmentioning

confidence: 99%

Lobectomy versus segmentectomy for stage IA3 (T1cN0M0) non-small cell lung cancer: a meta-analysis and systematic review

Zhang,

Chen,

Lin

et al. 2023

Front. Oncol.

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“…Two authors (FD and SeS) performed an independent literature search on 1 July 2023, according to predefined standards [ 17 , 18 ] to guarantee that no patient is included multiple times in the meta-analysis despite compiling cohorts from similar data sources. Figure 1 provides a detailed flowchart of the search strategy.…”

Section: Methodsmentioning

confidence: 99%

“…Assessment of study quality and risk of bias was conducted by two independent investigators (FD and SeS) using the ROBINS-I tool (version for cohort-type studies; 19 September 2016) [ 19 ]. To avoid a staging bias, all studies were evaluated regarding predefined staging conditions [ 17 , 18 ].…”

Section: Methodsmentioning

confidence: 99%

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Closing the RCT Gap—A Large Meta-Analysis on the Role of Surgery in Stage I–III Small Cell Lung Cancer Patients

Doerr,

Stange,

Salamon

et al. 2024

Cancers

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Introduction: Despite clear guideline recommendations, surgery is not consistently carried out as part of multimodal therapy in stage I small cell lung cancer (SCLC) patients. The role of surgery in stages II and III is even more controversial. In the absence of current randomized control trials (RCT), we performed a meta-analysis comparing surgery versus non-surgical treatment in stage I to III SCLC patients. Methods: A systematic review of the literature was conducted on 1 July 2023, focusing on studies pertaining to the impact of surgery on small cell lung cancer (SCLC). These studies were evaluated using the ROBINS-I tool. Statistical analyses, including I² tests, Q-statistics, DerSimonian-Laird tests, and Egger regression, were performed to assess the data. In addition, 5-year survival rates were analyzed. The meta-analysis was conducted according to PRISMA standards. Results: Among the 6826 records identified, 10 original studies encompassing a collective cohort of 95,323 patients were incorporated into this meta-analysis. Heterogeneity was observed across the included studies, with no discernible indication of publication bias. Analysis of patient characteristics revealed no significant differences between the two groups (p-value > 0.05). The 5-year survival rates in a combined analysis of patients in stages I–III were 39.6 ± 15.3% for the ‘surgery group’ and 16.7 ± 12.7% for the ‘non-surgery group’ (p-value < 0.0001). SCLC patients in stages II and III treated outside the guideline with surgery had a significantly better 5-year survival compared to non-surgery controls (36.3 ± 20.2% vs. 20.2 ± 17.0%; p-value = 0.043). Conclusions: In the absence of current RCTs, this meta-analysis provides robust suggestions that surgery might significantly improve survival in all SCLC stages. Non-surgical therapy could lead to a shortening of life. The feasibility of surgery in non-metastatic SCLC should always be evaluated as part of a multimodal treatment.

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“…The latest National Comprehensive Cancer Network guideline confirmed that only candidates with clinical stage I–IIA SCLC could benefit from surgery 6 . However, surgery for LS-SCLC has increasingly garnered interest recently, with many researchers confirming that LS-SCLC patients could benefit from tumor resection 7–11 …”

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confidence: 99%

Prognostic Relevance of Negative Lymph Node Count in Resected Stage I–IIIa Small-cell Lung Cancer

Yang¹,

Liu

2023

American Journal of Clinical Oncology

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Objectives: The prognostic significance of the negative lymph node (NLN) count has been confirmed in various cancers but not in small-cell lung cancer (SCLC). We aimed to evaluate the correlation between the NLN count and the prognosis of patients with stages I–IIIa SCLC who underwent lobectomy. Methods: Data on the clinical characteristics of SCLC patients who underwent lobectomy between 2000 and 2019 were collected from the SEER database and organized based on the X-tile plots to identify the optimal cutoff point for the NLN count. Kaplan–Meier curves and a Cox proportional hazard model were used to evaluate the prognostic factors for overall survival (OS) and lung cancer-specific survival. Results: Based on the X-tile plot-determined cutoff points of 3 and 7, the participants were grouped into the low (<3), middle (3–7), and high (>7) NLN subgroups for the analysis of OS. Univariable analysis showed that a higher NLN count correlated with more favorable OS and lung cancer-specific survival (both P<0.001). Multivariate analysis demonstrated that, after adjustment for related factors, the NLN count was positively associated with the prognosis and might thus be an independent risk factor for prognosis. Subgroup analyses revealed that, among different LN statuses and varied positive LN counts, the NLN count could predict the prognosis independently. Conclusions: Higher NLNs correlated with better survival for patients who underwent lobectomy of stages I–IIIa SCLC. A predictive marker that combines the NLN count with the N stage and positive LN count could provide more prognostic information in SCLC.

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Redefining the role of surgery in early small-cell lung cancer

Cited by 5 publications

References 43 publications

Lobectomy versus segmentectomy for stage IA3 (T1cN0M0) non-small cell lung cancer: a meta-analysis and systematic review

Lobectomy versus segmentectomy for stage IA3 (T1cN0M0) non-small cell lung cancer: a meta-analysis and systematic review

Closing the RCT Gap—A Large Meta-Analysis on the Role of Surgery in Stage I–III Small Cell Lung Cancer Patients

Prognostic Relevance of Negative Lymph Node Count in Resected Stage I–IIIa Small-cell Lung Cancer

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