Survival outcomes with the use of surgery in limited-stage small cell lung cancer. Should its role be re-evaluated?
David Schreiber, MD    Cancer  2010. Published Online: Jan 15 2010
Department of Radiation Oncology, State University of New York Downstate Medical Center, Brooklyn, New York
 

BACKGROUND:
Although chemotherapy and radiation therapy currently are recommended in limited-stage small cell lung cancer (L-SCLC), several small series have reported favorable survival outcomes in patients who underwent surgical resection. The authors of this report used a US population-based database to determine survival outcomes of patients who underwent surgery.
 
The Surveillance, Epidemiology, and End Results (SEER) registry was used to identify patients who were diagnosed with L-SCLC between 1988 and 2002 coded by SEER as localized disease (T1-T2Nx-N0) or regional disease (T3-T4Nx-N0). Kaplan-Meier and Cox regression analyses were used to compare overall survival (OS) for all patients.

RESULTS:
In total, 14,179 patients were identified, including 863 patients who underwent surgical resection. Surgery was associated more commonly with T1/T2 disease. Surgery was associated with improved survival for both localized disease and regional disease with improvements in median survival from 15 months to 42 months and from 12 months to 22 months respectively.

Lobectomy was associated with the best outcome. Patients with localized disease who underwent lobectomy with had a median survival of 65 months and a 5-year OS rate of 52.6%; whereas patients who had regional disease had a median survival of 25 months and a 5-year OS rate of 31.8%. On multivariate analysis, the benefit of surgery varied in a time-dependant fashion. However, the benefit of lobectomy remained across all time intervals.

CONCLUSIONS:
The use of surgery, and particularly lobectomy, in selected patients with L-SCLC was associated with improved survival outcomes. Future prospective studies should consider the role of surgery as part of the multimodality management of this disease.