Role of surgery in a case-control study of patients with clinical stage IIIA small cell lung cancer

Shuangyi Li; Kaiqi Jin; Yingying Pan; Chunxiao Wu; Shengxiang Ren; Gening Jiang; Peng Zhang

doi:10.21037/jtd-20-3047

Role of surgery in a case-control study of patients with clinical stage IIIA small cell lung cancer

J Thorac Dis. 2021 May;13(5):2738-2745. doi: 10.21037/jtd-20-3047.

Authors

Shuangyi Li¹, Kaiqi Jin¹, Yingying Pan², Chunxiao Wu³, Shengxiang Ren², Gening Jiang¹, Peng Zhang¹

Affiliations

¹ Department of Thoracic Surgery, Tongji University Affiliated Shanghai Pulmonary Hospital, Tongji University School of Medicine, Shanghai, China.
² Department of Oncology, Tongji University Affiliated Shanghai Pulmonary Hospital, Tongji University School of Medicine, Shanghai, China.
³ Shanghai Municipal Center for Disease Control and Prevention, Shanghai, China.

Abstract

Background: The role of surgery in the multidisciplinary treatment of clinical stage IIIA small cell lung cancer is yet to be verified. This study was performed to determine the benefit of surgery in patients with stage IIIA small cell lung cancer.

Methods: Patients diagnosed with stage IIIA small cell lung cancer at Shanghai Pulmonary Hospital from 2005 to 2015 were included and divided into two groups: the surgery with neoadjuvant and adjuvant chemotherapy group and the concurrent chemo-radiotherapy group. Overall survival was compared between the two groups. A multivariate Cox regression model was constructed to evaluate factors associated with overall survival.

Results: Of 69 patients with stage IIIA small cell lung cancer during the study period, 40 patients (58%) underwent surgery with neoadjuvant and adjuvant chemotherapy, and 29 patients (42%) underwent concurrent chemo-radiotherapy. Patients in the surgery with neoadjuvant and adjuvant chemotherapy group had a longer overall survival compared with patients in the concurrent chemo-radiotherapy group (median survival: 33.1 vs. 16.2 months, respectively; 2-year overall survival: 44.2% vs. 14.9%, respectively; log-rank: P=0.045). A multivariate analysis revealed that surgery with neoadjuvant and adjuvant chemotherapy (hazard ratio: 0.374; 95% confidence interval: 0.173-0.808, P=0.012) was independently associated with overall survival.

Conclusions: Patients with stage IIIA small cell lung cancer treated with surgical resection plus chemotherapy demonstrated longer overall survival compared with those who underwent concurrent chemo-radiotherapy. Surgery may be an option for clinical stage IIIA small cell lung cancer after induction chemotherapy in selected patients.

Keywords: Small cell lung cancer (SCLC); chemotherapy; surgery.