Stage I and II Small-Cell Lung Cancer—New Challenge for Surgery

Abstract

Purpose The recommended treatment for small-cell lung cancer (SCLC) currently is surgery in stage I disease. We wondered about stage II SCLC and present a meta-analysis on mean-survival of patients that underwent surgery for stage I and II compared to controls. Methods A systematic literature search was performed on December 01st 2021 in Medline, Embase and Cochrane Library. We considered studies published on the effect of surgery in SCLC since 2004 and assessed them using ROBINS-I. We preformed I2-tests, Q-statistics, DerSimonian-Laird tests and Egger-regression. The meta-analysis was conducted according to PRISMA. Results Out of 6826 records, seven studies with a total of 11,241 patients (‘surgery group’: 3911 patients; ‘non-surgery group’: 7330; treatment period: 1984–2015) were included. Heterogeneity between the studies was revealed in absence of any publication bias. Patient characteristics did not differ between the groups (p-value > 0.05). The mean-survival in an analysis of patients in stage I was 36.7 ± 10.8 months for the ‘surgery group’ and 20.3 ± 5.7 months for the ‘non-surgery group’ (p-value = 0.0084). A combined analysis of patients in stage I and II revealed a mean-survival of 32.0 ± 16.7 months for the ‘surgery group’ and 19.1 ± 6.1 months for the ‘non-surgery group’ (p-value = 0.0391). In a separate analysis of stage II, we were able to demonstrate a significant survival benefit after surgery (21.4 ± 3.6 versus 16.2 ± 3.9 months; p-value = 0.0493). Conclusion Our meta-analysis shows a significant survival benefit after surgery not only in the recommended stage I but also in stage II SCLC. Our data suggests that both stages should be considered for surgery of early SCLC.

Construction and validation of a nomogram based on the log odds of positive lymph nodes to predict cancer-specific survival in patients with small cell lung cancer after surgery

“…Surgery is the main method of cancer treatment, although a previous trial has demonstrated that radiotherapy resulted in a better prognosis than surgery for SCLC patients before the 1970s [ 5 ]. In-depth research has allowed patients with stage I–II and even stage III N2 SCLC to be regarded as a surgical evaluation population [ [6] , [7] , [8] , [9] ]. Multiple studies have shown that the management of surgery can prolong the survival time of early-stage SCLC patients compared to those treated with concurrent chemoradiation [ 10 , 11 ].…”

A practical nomogram for predicting early death in elderly small cell lung cancer patients: A SEER-based study

“…While radical surgery has proven effective for early stage SCLC patients with T1-2N0M0, it should be noted that this subset represents a mere 5% of all LS-SCLC cases, making the benefits of surgery challenging to extend beyond this limited group. [41–43] The analysis of this study showed that the rates of surgery in elderly SCLC patients with stage I–IV were 36.1%, 22.3%, 6%, and 1.1%. Overall, the early mortality rates for patients who did not receive versus those who received surgical treatment were 38.5% and 11.8%, respectively, suggesting that the risk of early death is markedly reduced in elderly SCLC patients after surgery.…”

Survival analysis of surgical versus nonsurgical treatment in stage I to III small cell lung cancer in the last 20 years: A systematic review and meta‐analysis

“…In addition, the subgroup analysis of the retrospective study showed that the OS rate of patients who received surgical treatment was higher regardless of whether they had stage I (HR: 0.56,95% CI: 0.49–0.64, p < 0.001), II (HR: 0.75, 95% CI: 0.57–0.99, p = 0.04) or III disease (HR: 0.70, 95% CI: 0.56–0.88, p = 0.002). In 2022, Doerr et al 27 conducted a meta‐analysis of 11 241 stage I–II SCLC patients in seven studies between 1984 and 2015. The results showed that the average survival time of stage I patients was 36.7 ± 10.8 months in the surgical group and 20.3 ± 5.7 months in the nonsurgical group ( p = 0.0084).…”