Lobectomy leads to optimal survival in early-stage small cell lung cancer: A retrospective analysis

• Published in: The Journal of thoracic and cardiovascular surgery Vol. 142; no. 3; pp. 538 - 546
• Main Authors: Varlotto, John M., MD, Recht, Abram, MD, Flickinger, John C., MD, Medford-Davis, Laura N., BA, Dyer, Anne-Marie, MS, DeCamp, Malcolm M., MD
• Format: Journal Article
• Language: English
• Published: New York, NY Mosby, Inc 01-09-2011; Elsevier
• Subjects: Adult; Aged; Aged, 80 and over; Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy; Biological and medical sciences; Cardiology. Vascular system; Cardiothoracic Surgery; Combined Modality Therapy; Female; Humans; Incidence; Lung Neoplasms - mortality; Lung Neoplasms - pathology; Lung Neoplasms - radiotherapy; Lung Neoplasms - surgery; Male; Medical sciences; Middle Aged; Multivariate Analysis; Neoplasm Staging; Pneumology; Pneumonectomy; Proportional Hazards Models; Retrospective Studies; SEER Program; Small Cell Lung Carcinoma - mortality; Small Cell Lung Carcinoma - pathology; Small Cell Lung Carcinoma - radiotherapy; Small Cell Lung Carcinoma - surgery; Survival Analysis; Young Adult; SCLC; RT; NSCLC; CI; not otherwise specified; non–small cell lung cancer; HR; 10.4; NOS; 10.2; LCSS; hazard ratio; radiotherapy; SEER; confidence interval; Surveillance, Epidemiology, and End Results; small cell lung cancer; 10; lung cancer-specific survival; Prognosis; Lung; Early stage; Malignant tumor; Survival; Retrospective; Treatment; Surgery; Analysis; Lead; Anesthesia; Circulatory system; Cardiology; Small cell carcinoma; Lobectomy; Cancer
• ISSN: 0022-5223; 1097-685X
• DOI: 10.1016/j.jtcvs.2010.11.062

Objective Stage I or II small cell lung cancer is rare. We evaluated the contemporary incidence of early-stage small cell lung cancer and defined its optimal local therapy. Methods We analyzed the incidence, treatment patterns, and outcomes of 2214 patients with early-stage small cell lung cancer (1690 with stage I and 524 with stage II) identified from the Surveillance, Epidemiology, and End Results database from 1988 to 2005. Results Early-stage small cell lung cancer constituted a stable proportion of all small cell lung cancers (3%–5%), lung cancers (0.10%–0.17%), and stage I lung cancers (1%–1.5%) until 2003 but, by 2005, increased significantly to 7%, 0.29%, and 2.2%, respectively ( P  < .0001). Surgery for early-stage small cell lung cancer peaked at 47% in 1990 but declined to 16% by 2005. Patients treated with lobectomy or greater resections (lobe) without radiotherapy had longer median survival (50 months) than those treated with sublobar resections (sublobe) without radiotherapy (30 months, P  = .006) or those treated with radiotherapy alone (20 months, P  < .0001). Patients undergoing sublobe without radiotherapy also demonstrated superior survival than patients receiving radiotherapy alone ( P  = .002). The use or omission of radiotherapy made no difference after limited resection (30 vs 28 months, P  = .6). Multivariable analysis found survival independently related to age, year of diagnosis, tumor size, stage, and treatment (lobe vs sublobe vs radiotherapy alone). Conclusions Surgery is an underused modality in the management of early-stage small cell lung cancer. Lobectomy provides optimal local control and leads to superior survival. Although sublobar resection proved inferior to lobectomy, it conferred a survival advantage superior to radiotherapy alone. The addition of radiotherapy to resection provided no additional benefit.