Abstract
Surgery is commonly recommended for patients with stage I small-cell lung cancer (SCLC), whereas chemotherapy and radiotherapy are considered the standard treatment for patients with stage III SCLC. However, recent studies have suggested that a small proportion of patients with SCLC at an advanced stage may benefit from surgical resection. Therefore, in this study, we investigated the effectiveness of surgery in patients with stage III SCLC. Patients were selected from the Surveillance, Epidemiology, and End Results (SEER) database between 2004 and 2013. Propensity score matching (PSM) was used to eliminate any clinical bias. The overall survival (OS) was determined using the Kaplan–Meier method and compared using the log-rank test. The Cox proportional-hazards model was used to identify the effect of surgery on the OS. Of 9606 patients with stage III SCLC, 234 underwent surgery. Compared with the non-surgical group, a higher proportion of patients undergoing surgery had T1 and N0-N1 disease (risen by 10.7% for T1; 12.6% for N0-N1) and a lower proportion had T4 and N3 disease (decreased by 14.3% for T4; 12.5% for N3). The Kaplan-Meier analysis showed that patients who underwent surgery had a better OS before and after PSM. The multivariate analysis showed that surgery was beneficial for patients with stage III SCLC (HR: 0.651, 95% CI 0.524–0.808, P < 0.001). In conclusion, surgical resection might be associated with improved OS for patients with stage III SCLC and may be considered for the treatment of these patients. Further prospective studies are required to confirm these findings.
Highlights
The incidence of lung cancer, which is the leading cause of cancer-related death worldwide, has been rising [1, 2]
There was no significant difference in age, gender, race, and use of radiotherapy between the patients in the surgical and non-surgical groups
The doubling time of tumor cells of Small-cell lung cancer (SCLC) is as short as 23 days whereas that of squamous cell carcinoma and adenocarcinoma is 88 and 166 days, respectively
Summary
The incidence of lung cancer, which is the leading cause of cancer-related death worldwide, has been rising [1, 2]. Surgical resection was recommended for limited stage SCLC. Surgery is suitable for SCLC at the early stages. Surgical resection of small lesions without lymph node involvement has been considered a curative strategy for patients with SCLC at an early stage. The benefit of surgery is limited to patients with SCLC at an early stage. An increasing number of studies have suggested that surgical resection can prolong the overall survival (OS) in patients with SCLC at an advanced stage [9, 10]. To further investigate the effect of surgery on patients with stage III SCLC, we performed a retrospective analysis using the Surveillance, Epidemiology, and End Results (SEER) database
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