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

Dongliang Bian; Siming Jiang; Yicheng Xiong; Mengfan Qi; Jiawei Wu; Alfredo Addeo; Yoshikane Yamauchi; Farkhad Manapov; Wolfram C M Dempke; Jacopo Vannucci; Alessandro Di Federico; Xiaoxiong Xu; Linsong Chen

doi:10.21037/tlcr-22-545

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

Transl Lung Cancer Res. 2022 Aug;11(8):1631-1642. doi: 10.21037/tlcr-22-545.

Authors

Dongliang Bian^#^{1

2}, Siming Jiang^#², Yicheng Xiong^#^{1

2}, Mengfan Qi^{1

2}, Jiawei Wu^{1

2}, Alfredo Addeo³, Yoshikane Yamauchi⁴, Farkhad Manapov⁵, Wolfram C M Dempke⁶, Jacopo Vannucci⁷, Alessandro Di Federico⁸, Xiaoxiong Xu², Linsong Chen²

Affiliations

¹ Department of Thoracic Surgery, Shanghai Pulmonary Hospital, Tongji University School of Medicine, Shanghai, China.
² Department of Thoracic Surgery, Tongji University Affiliated Shanghai Pulmonary Hospital, Shanghai, China.
³ Oncology Department, University Hospital of Geneva, Geneva, Switzerland.
⁴ Department of Surgery, Teikyo University School of Medicine, Tokyo, Japan.
⁵ Department of Radiation Oncology, University Hospital Ludwig Maximilian University of Munich (LMU), Munich, Germany.
⁶ Department of Haematology and Oncology, University Medical School Munich, Munich, Germany.
⁷ Thoracic Surgery Unit, Policlinico Umberto I, Sapienza University of Rome, Rome, Italy.
⁸ Division of Medical Oncology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy.

^# Contributed equally.

Abstract

Background: The efficacy of surgery in combination of chemotherapy for stage IIIA small cell lung cancer (IIIA-SCLC) is controversial. The aim of the present study was to analyze the efficacy of surgery combined with chemotherapy, especially in the setting of neoadjuvant chemotherapy (NAC) followed by surgery for IIIA-SCLC.

Methods: Between 2004 and 2015, we reviewed 2,199 chemotherapy-treated stage IIIA (N1/2) SCLC cases in the Surveillance, Epidemiology, and End Results (SEER) database, and 32 NAC + intentional radical resection-treated, centrally-located IIIA-SCLC cases at Shanghai Pulmonary Hospital (SPH). Outcomes were compared between surgically and non-surgically treated patients from the SEER database after propensity score matching (PSM), and comparing lobectomy/bi-lobectomy and pneumonectomy patients from SPH. Prognostic factors were evaluated by Kaplan-Meier method and the Cox proportional hazards regression model.

Results: There was significantly higher overall survival (OS) in surgically treated IIIA-SCLC patients (OS, 44.8 vs. 21.2 months, P=0.048), and similar efficacy was observed between sub-lobectomy and lobectomy/bi-lobectomy patients (OS: 55.6 vs. 30.3 months, P=0.167) in SEER database. At SPH, significantly higher OS was associated with T1 stage (before NAC: T1 vs. T2-4, 48.7 vs. 32.2 months, P=0.025; after NAC: T1 vs. T2-4, 42.7 vs. 21.3 months, P=0.048). Female sex [hazard ratio (HR): 0.078, P=0.009], T1 stage (HR: 13.048, P=0.026), and pneumonectomy (HR: 0.095, P=0.009) were independent prognostic factors for IIIA-SCLC patients who received NAC + intentional radical resection.

Conclusions: For stage IIIA SCLC patients, complete resection combined with chemotherapy might improve the prognosis than patients without surgery. Post-NAC lobectomy was not found to be superior to sub-lobectomy, while pneumonectomy was considered suitable for central-type IIIA-SCLC patients after NAC treatment.

Keywords: Small cell lung cancer (SCLC); limited disease; neoadjuvant chemotherapy (NAC); surgery.