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Role of surgery in patients with early stage small-cell lung cancer

Authors Peng A, Li G, Xiong M, Xie S, Wang C

Received 20 January 2019

Accepted for publication 21 June 2019

Published 26 July 2019 Volume 2019:11 Pages 7089—7101

DOI https://doi.org/10.2147/CMAR.S202283

Checked for plagiarism Yes

Review by Single-blind

Peer reviewers approved by Dr Colin Mak

Peer reviewer comments 2

Editor who approved publication: Dr Sanjeev Srivastava


Aimei Peng,*,1 Guoshu Li,*,1 Mengting Xiong,*,2 Shuanshuan Xie,1 Changhui Wang1

1Department of Respiratory Medicine, Shanghai Tenth People’s Hospital, Tongji University, Shanghai 200072, People’s Republic of China; 2Department of Respiratory Medicine, Pulmonary Hospital, Tongji University, Shanghai 200433, People’s Republic of China

*These authors contributed equally to this work

Purpose: Currently, systemic chemotherapy combined with thoracic radiation is the standard treatment for patients with small-cell lung cancer (SCLC). However, the treatment of early stage SCLC remains controversial. This study evaluated the survival outcomes of surgical treatments and the effect of adjuvant chemotherapy and radiotherapy on lung cancer-specific survival (LCSS) in patients with early stage SCLC.
Methods: Using the Surveillance, Epidemiology, and End Results registry, we identified 2,453 patients with early stage SCLC (1,295 women and 1,158 men) who had complete clinical information between 2004 and 2015. The Kaplan-Meier analysis was used to determine the propensity score based on the characteristics of patients with early stage SCLC. LCSS was compared between patients treated with surgery and non-surgery after adjusting, stratifying, or matching patients with early stage SCLC. In addition, we compared the effects of chemotherapy and radiotherapy on LCSS in patients with early stage SCLC.
Results: Overall, 687 (28.0%) and 1,766 (72.0%) patients with early stage SCLC did and did not undergo surgery, respectively. Kaplan-Meier analysis demonstrated a statistically significant difference in survival curves between the surgery and non-surgery groups (log-rank p<0.001). Compared with the non-surgery group, the LCSS of the surgery group was better (hazard ratio [HR]:0.494, 95% confidence interval [CI]:0.415–0.587, p<0.001) in patients with early stage SCLC when using a Cox model for multivariate analysis. There was no statistically significant difference (p=0.847) in LCSS between patients with early stage SCLC with and without chemotherapy in the multivariate analysis. Radiotherapy had favorable effects on LCSS (HR: 0.579, 95% CI: 0.500–0.671, p<0.001) in patients with early stage SCLC using multivariate analysis.
Conclusions: Our study results suggest that LCSS conferred by surgery was higher than that conferred by non-surgery and that radiotherapy is associated with better survival in patients with early stage SCLC. This study findings should be confirmed in prospective studies.

Keywords: early stage small-cell lung cancer, surgery, lung cancer-specific survival, SEER, chemotherapy, radiotherapy

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