Surgery in patients with small cell lung cancer: A period propensity score matching analysis of the Seer database, 2010‑2015

Abstract

Surgery as a therapeutic modality for non-small cell lung cancer is widely accepted in clinical practice. However, the role of surgery for small cell lung cancer (SCLC) remains controversial. Therefore, in the present study a period propensity score matching analysis using the Surveillance, Epidemiology and End Results (SEER) Registry database was performed to investigate the role of surgery on survival in patients with SCLC. Patients with SCLC between January 2010 and December 2015 were identified from the SEER database, and individual data for each case regarding general clinical characteristics, surgery of primary site (SPS), cause-specific death classification and survival time were retrieved. Differences of cause-specific survival (CSS) between subgroups were estimated by the log-rank test. Cox regression analysis was used to evaluate the effects of multiple variables on CSS, and differences between the incidences of cause-specific death were examined using a χ2 test. A total of 1,707 records met the inclusion criteria and were retrieved for analysis. There were significant differences of CSS in the clinicopathological features of N (P=0.01), Stage (P<0.01) and Surgery (P<0.01) when comparing non-surgery with surgery, and in N (P<0.001), Stage (P=0.006) and Surgery (P=0.049) when comparing sublobectomy with lobectomy or bilobectomy (lobe/s). Patients who did not receive surgery (P<0.001) or who received sublobectomy (P=0.03) had an increased risk of mortality when compared with patients who received surgery and lobe/s. The findings of the present study indicate that surgery should be taken into consideration when an initial treatment strategy is made in patients for patients with SCLC at clinical stage I–IIA (T1-2,N0,M0), regardless of whether they are >50 years of age, their sex, histology and grade. The results suggest that certain patients with SCLC with stage IIB (N1) can also benefit from lobe/s, although further investigation is required. In addition, lobe/s is preferable to sublobectomy when surgery is performed. However, the present study was unable to comprehensively analyze the efficacy of pneumonectomy for SCLC.

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

“…The authors found that patients who did not receive surgery had an increased risk of death when compared with patients who did. The results support that patients with SCLC with Stage I-IIA (T1-2N0M0) and selected IIB (N1) may benefit from surgery [105]. Similar results were found by Peng et al in regard to the impact of surgery on lung cancer specific survival in a cohort of 2453 patients with early stage SCLC from the SEER database [106].…”

“…Regarding the type of resection, there is evidence suggesting that patients who underwent a lobectomy had significant better OS over sublobar resection [8,53,65,67,86,87,90,102,105]. In the retrospective study of SCLC patients in the National Cancer Data Base published by Combs et al, lobectomy was associated with a 5-year overall survival of 40% compared with 21% for sublobar and 22% for pneumonectomy (HR for death after sublobar resections vs. lobectomy 1.38,95% CI 1.12-1.71) [102].…”

Brain Metastasis in Patients with Small Cell Lung Cancer

“…Second, the SEER database lacks additional data regarding smoking exposure pack-years, comorbidities and previous or current possible brain vascular diseases, which may conceal some important risk factors. 23 Third, as the time, sequence and combination of different treatments varied widely, 24 we could not thoroughly evaluate the effect of such clinical factors on SCLC patients with BM. So, our results should be explained with caution, and future prospective clinical trials are necessary to validate our findings.…”

New perspectives in the management of small cell lung cancer

“…Lobectomy is the preferred procedure for surgical resection, as it is associated with significantly better survival than sublobar resection[ 40 , 45 , 49 , 54 , 63 ]. The significant discrepancies observed between clinical and pathologic stages (mainly due to undetected lymph node metastasis before surgery) highlight the importance of accurate clinical nodal staging and systematic lymph node dissection[ 47 , 64 ].…”