Abstract
BackgroundThe optimal postoperative treatment strategy for small cell lung cancer (SCLC) remains unclear, especially in patients with lymph node metastasis. We aimed to compare the outcomes of patients with SCLC and lymph node metastasis treated with postoperative adjuvant chemotherapy or chemoradiotherapy.MethodsWe retrospectively collected data on patients with postoperative SCLC diagnosed with N1 and N2 lymph node metastasis from the Diagnosis Procedure Combination database in Japan, between July 2010 and March 2015. We extracted data on patient age, sex, comorbidities, and TNM classification at lung surgery; operative procedures, chemotherapy drugs, and radiotherapy during hospitalization; and discharge status. Recurrence-free survival was compared between the chemotherapy and chemoradiotherapy groups using multivariable Cox regression analysis.ResultsMedian recurrence-free survival was 1146 days (95% confidence interval [CI], 885–1407) in the chemotherapy group (n = 489) and 873 days (95% CI, 464–1282) in the chemoradiotherapy group (n = 75). There was no significant difference between these after adjusting for patient backgrounds (hazard ratio, 1.29; 95% CI, 0.91–1.84).ConclusionsThere was no significant difference in recurrence-free survival between patients with SCLC and N1-2 lymph node metastasis treated with postoperative adjuvant chemotherapy and chemoradiotherapy. Further randomized clinical trials are needed to address this issue.
Highlights
The optimal postoperative treatment strategy for small cell lung cancer (SCLC) remains unclear, especially in patients with lymph node metastasis
Patient characteristics We identified 564 patients with SCLC who underwent lung resection followed by adjuvant chemotherapy (n = 489) or chemoradiotherapy (n = 75) during the study period
The proportion of women was higher in the chemotherapy than in the chemoradiotherapy group (P = 0.038), but there were no significant differences between the groups in any other patient characteristics
Summary
The optimal postoperative treatment strategy for small cell lung cancer (SCLC) remains unclear, especially in patients with lymph node metastasis. We aimed to compare the outcomes of patients with SCLC and lymph node metastasis treated with postoperative adjuvant chemotherapy or chemoradiotherapy. Small cell lung cancer (SCLC) comprises 10%–20% of all lung cancers [1]. Surgery is not appropriate in most SCLC patients, and only about 5% of SCLCs are considered to be surgically resectable [2]. In the case of postoperative SCLC with regional lymph node metastasis, European Society for Medical Oncology guidelines [3] and Japanese consensus. The aim of this study was to compare the prognosis of patients with SCLC diagnosed with regional lymph node metastasis treated with postoperative adjuvant chemotherapy or chemoradiotherapy, using information from a national inpatient database in Japan
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