Impact of treatment modality on long-term survival of stage IA small-cell lung cancer patients: a cohort study of the U.S. SEER database

Shao-Feng Lin; Yu-Zhen Zheng; Xiao-Qiang Li; Hai-Peng Xu; Jun-Jie Wang; Wei Wang; Qing-Yuan Huang; Da Wu; Chen-Xi Zhong; Shen-Shen Fu; Lian-Xiong Yuan; Si-Chao Wang; Rui-Xing Luo; Wen-Yu Zhai; Ben-Tong Yu; Kun-Shou Zhu

doi:10.21037/atm-20-5525

Impact of treatment modality on long-term survival of stage IA small-cell lung cancer patients: a cohort study of the U.S. SEER database

Ann Transl Med. 2020 Oct;8(20):1292. doi: 10.21037/atm-20-5525.

Authors

Shao-Feng Lin¹, Yu-Zhen Zheng², Xiao-Qiang Li³, Hai-Peng Xu⁴, Jun-Jie Wang⁵, Wei Wang⁶, Qing-Yuan Huang⁷, Da Wu³, Chen-Xi Zhong⁸, Shen-Shen Fu⁹, Lian-Xiong Yuan¹⁰, Si-Chao Wang¹¹, Rui-Xing Luo³, Wen-Yu Zhai¹², Ben-Tong Yu¹³, Kun-Shou Zhu¹

Affiliations

¹ Department of Thoracic Surgery, Fujian Cancer Hospital & Fujian Medical University Cancer Hospital& Fujian Provincial Key Laboratory of Tumor Biotherapy, Fuzhou, China.
² Department of Thoracic Surgery, The Sixth Affiliated Hospital, Sun Yat-sen University, Guangzhou, China.
³ Department of Thoracic Surgery, Peking University Shenzhen Hospital, Shenzhen, China.
⁴ Department of Thoracic Oncology, Fujian Cancer Hospital & Fujian Medical University Cancer Hospital, Fuzhou, China.
⁵ Department of Surgery, Cleveland Clinic, Cleveland, Ohio, USA.
⁶ S. Arthur Localio Laboratory, Department of Surgery, New York University School of Medicine, New York, NY, USA.
⁷ Department of Thoracic Surgery, Shanghai First People's Hospital, Shanghai Jiao Tong University, Shanghai, China.
⁸ Department of Thoracic Surgery, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai, China.
⁹ Department of Ultrasonography, Guangzhou First People's Hospital, Guangzhou Medical University, Guangzhou, China.
¹⁰ Office of Research Service, Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, Guangzhou, China.
¹¹ Department of Thoracic Surgery, Guangdong Provincial People's Hospital, Guangzhou, China.
¹² Department of Thoracic Oncology, Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation, Guangzhou, China.
¹³ Department of Thoracic Surgery, First Affiliated Hospital of Nanchang University, Nanchang, China.

Abstract

Background: The optimal treatment modality for patients with stage IA (T1N0M0) small-cell lung cancer (SCLC) is still unclear.

Methods: Patients who received surgical resection or chemo-radiotherapy (CRT) between January 2004 and December 2014 were identified from The Surveillance, Epidemiology and End Results (SEER) database. Surgical resection included lobectomy, wedge resection, segmentectomy with lymphadenectomy [examined lymph node (ELN) ≥1]. Propensity score match analysis was utilized to balance the baseline characteristics.

Results: A total of 686 stage IA SCLC cases were included: 337 patients underwent surgery and 349 patients were treated by CRT alone. Surgery achieved a better outcome than CRT alone, with an adjusted hazard ratio (HR) of 0.495. Patients who underwent lobectomy demonstrated a longer overall survival (OS), compared to those who received sublobectomy (crude cohort, median OS, 69 vs. 38 months; match cohort, median OS, 67 vs. 38 months). Patients with ELN >7 presented with longer OS than those with ELN ≤7 (crude cohort, median OS, 91 vs. 49 months; matched cohort, median OS, 91 vs. 54 months). The additional efficacy of chemotherapy or radiotherapy in patients receiving lobectomy was observed. The best prognosis was achieved in the lobectomy plus CRT cohort, with a 5-year survival rate of 73.5%.

Conclusions: The prolonged survival associated with lobectomy and chemotherapy or radiotherapy presents a viable treatment option in the management of patients with stage IA SCLC.

Keywords: SEER; Small-cell lung cancer (SCLC); early-stage lung cancer; treatment.