P2.12-24 Underutilization of Surgery for Localized Small Cell Lung Cancer: A Nationwide Analysis

Abstract

Although surgery has been recommended in node-negative localized small-cell lung cancer (SCLC), utilization has been low (<10%) in the past. Here, we evaluate treatment patterns and outcomes of surgery in localized SCLC over the last decade to determine if routine practice follows the growing literature in support of surgery in localized SCLC. We queried years 2006-2014 of the National Cancer Database, a hospital dataset capturing 70% of incident cancers in the United States, to identify adults with Stage IA to IIA (T1-T2N0M0) SCLC who underwent treatment. Temporal practice patterns and multivariable survival outcomes were assessed. In the cohort of 5877 patients, 2892 (49%) received chemoradiation, 1300 (22%) received surgery with radiation or chemotherapy, 639 (11%) received chemotherapy alone, 628 (11%) received surgery alone, and 418 (7%) received radiation alone. Amongst patients receiving surgery, 1277 (66%) received a lobectomy or pneumonectomy. Likelihood of receiving surgery in combination with radiation or chemotherapy was higher in later years of diagnosis (15% in 2006 vs 25% in 2014, p<0.001). Stage IA was more prevalent in the group that received surgery alone (77%) or surgery with chemotherapy or radiation (75%) compared to chemoradiation (45%), chemotherapy (49%), and radiation (63%). Median overall survival was most favorable for surgery with chemotherapy or radiation (51.8 months) followed by surgery alone (33.2 months) compared to chemotherapy + radiation (26.2 months), radiation alone (17.8 months), and chemotherapy alone (11.8 months)(p<0.001). In a multivariable Cox model (Table), surgery with chemotherapy and/or radiation was associated with decreased mortality versus chemoradiation (hazard ratio=0.6, P<0.001).Tabled 1Hazard ratio95% CITreatment Chemoradiation Chemotherapy alone Radiation alone Surgery alone Surgery + chemotherapy or radiationRef 2.1 1.4 0.9 0.61.9-2.3 1.2-1.6 0.7-0.9 0.6-0.7Female sex0.80.8-0.9Stage IA IB IIARef 1.1 1.21-1.2 1.1-1.3*Model also included age, insurance, median income quartile, Charlson comorbidity score, region, and race (not shown) Open table in a new tab *Model also included age, insurance, median income quartile, Charlson comorbidity score, region, and race (not shown) Utilization of surgery in localized SCLC remains low, despite its association with improved survival. Future clinical trials may be needed to establish the best therapeutic strategy for these patients.