Under-treatment of small cell lung cancer: the case for surgical resection

Engelhardt, K; Odell, David D.; DeCamp, Malcom McAvoy

doi:10.21037/jtd.2017.08.156

Cited by 6 publications

(5 citation statements)

References 19 publications

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“…Contemporary surgical protocols predominantly derive from three randomized controlled trials (RCTs) conducted by Fox et al [ 11 ], Lad et al [ 12 ], and Liao et al [ 13 ]. These trials represent a robust level of evidence [ 14 ], yet they demonstrate minimal to negligible improvement in surgical interventions compared to alternative treatments in SCLC. Although a recent Cochrane review has highlighted challenges in interpreting these studies within the context of current standards, the authors persist in advocating against surgery for early-stage SCLC [ 43 ].…”

Section: Discussionmentioning

confidence: 99%

“…In the absence of modern staging technology and up-to date surgical techniques, surgery was found to be inferior to non-surgery treatment. Undoubtedly, a modern RCT would guarantee the best level of evidence [ 14 ]. Sadly, due to the rarity of resectable patients, conducting an RCT to evaluate the role of surgery in SCLC is complicated and may not be feasible in a single-site study [ 6 ].…”

Section: Introductionmentioning

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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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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

View full text Add to dashboard Cite

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“…Current surgical guidelines in SCLC are largely based on three RCTs by Fox et al [ 32 ], Lad et al [ 33 ] and Liao et al [ 34 ], which undoubtedly guarantee the best level of evidence [ 35 ], and which show little to no improvement of surgery over alternate treatment options. A recent Cochrane review pointed out difficulties in these studies’ interpretation under today’s standards [ 36 ].…”

Section: Discussionmentioning

confidence: 99%

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

Doerr

Stange

Michel

et al. 2022

Lung

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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.

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“…This issue of the Journal of Thoracic Diseases includes two well-written perspective pieces on our recent examination of surgery for early and locoregionally advanced small cell lung cancer (SCLC) (1,2). Our study found that surgical resection was associated with longer survival despite stagespecific propensity matching that accounted for patient, tumor and hospital characteristics (3).…”

mentioning

confidence: 84%

Surgery for small cell lung cancer in the modern era: opportunities and challenges

Wakeam

2017

J. Thorac. Dis.

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Under-treatment of small cell lung cancer: the case for surgical resection

Cited by 6 publications

References 19 publications

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

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

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

Surgery for small cell lung cancer in the modern era: opportunities and challenges

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