Surgery Plus Chemotherapy Versus Surgery Alone for Limited-Stage Small-Cell Lung Cancer: A Population-Based Survival Outcome Analysis

Abstract

IntroductionFor patients with limited-stage small-cell lung cancer (LS-SCLC), effective treatment methods still remain a clinical challenge. The aim of this study is to evaluate the survival outcome of surgery plus chemotherapy vs. surgery alone in patients with LS-SCLC.MethodsLS-SCLC patients selected from the Surveillance, Epidemiology and End Results (SEER) database diagnosed between January 1, 2004, and December 31, 2015. Comparison of overall survival (OS) and cancer-specific survival (CSS) between two groups performed propensity score matching (PSM), inverse probability of treatment weight (IPTW), and overlap weighting analysis.ResultsOf the 477 LS-SCLC patients identified from the SEER database between 2004 and 2015, 262 (54.9%) received surgery-plus-chemotherapy treatment and the others received surgery-alone treatment. Univariate and multivariate analyses showed that treatment option (P< 0.001), tumor location (P= 0.02) and AJCC stage (P< 0.001) were independent prognostic predictors of OS in LS-SCLC patients. Median OS was 35 months in surgery-plus-chemotherapy group vs. 23 months in surgery-alone group. Survival analysis showed that surgery plus chemotherapy offered significantly improved OS as compared with surgery-alone treatment before and after IPTW, PSM and overlap weighting method (all P< 0.05). According to AJCC stage stratification, OS of the unmatched patients with stage I (P= 0.049) and II (P= 0.001) SCLC who received surgery-plus-chemotherapy treatment was significantly better than that of surgery-alone patients.ConclusionsThis cohort study showed that surgery plus chemotherapy was associated with longer survival time than surgery alone in LS-SCLC patients, especially in those with stage I and II SCLC. Further prospective studies are required to confirm our conclusions.

Efficacy evaluation of surgery combined with chemotherapy for stage IIIA small cell lung cancer patients: a retrospective analysis

“…Previously published studies have demonstrated that patients with untreated limited and extensive SCLC (LD-SCLC and ED-SCLC) have an OS of about 6 and 2 months, respectively, and more than 80% of the patients undergoing standard therapies died within 2 years after diagnosis (8,9). For early-stage SCLC, particularly with no regional lymph node involvement, surgery combined with chemotherapy was the standard therapeutic regimen, and was found to significantly prolong OS (10)(11)(12). At the time of diagnosis, more than one third of patients who developed hilar and/or mediastinal lymph node (N1 and N2) involvement, which was defined as locally advanced SCLC (LA-SCLC) (13)(14)(15).…”

CD3, CD8, IFN-γ, tumor and stroma inflammatory cells as prognostic indicators for surgically resected SCLC: evidences from a 10-year retrospective study and immunohistochemical analysis

“…Ye and colleagues conducted a retrospective cohort study utilizing the SEER database. Their findings suggested that among stage I and II SCLC patients, those who underwent surgery combined with chemotherapy exhibited a longer OS compared to those who underwent surgery alone [ 25 ]. Other pertinent studies have consistently shown the survival advantages associated with adjuvant chemotherapy in patients with resected LS-SCLC [ 26 – 32 ].…”

The cross-regional settlement methods in hospitals and the treatment-seeking behavior of patients with malignant tumors in China: an evolutionary game model

“…And staying local for treatment can also save on the additional costs associated with cross-regional treatment. Regarding medical costs( ), the treatment expenses for patients in the surgical phase are significantly lower than for those requiring chemotherapy, targeted therapy, or immunotherapy ( 64 , 65 ), thus local treatment is advisable for patients in the surgical phase. Non-surgical patients, in search of better health insurance reimbursement policies, might choose to travel to regions with a broader coverage of health insurance.…”