Surgical resection in early limited-stage small cell lung cancer: Time to rethink? A retrospective analysis of the VA Central Cancer Registry.

Abstract

7021 Background: Concurrent chemoradiation is the standard of care for limited stage small cell lung cancer (L-SCLC). However, few reports suggest a survival benefit for surgical resection. Our objective is to analyze the outcomes of surgical resection for patients with L-SCLC. Methods: 8791 patients diagnosed with L-SCLC between 1995 and 2008, were identified from the VA Central Cancer Registry. These patients were then grouped according to age, sex, race, stage, grade and type of treatment received. Kaplan-Meier survival method and Cox proportional hazards model were used for analysis. Results: Out of 8,791 patients with L-SCLC, 915 (10.4%) had undergone surgical resection, while 5,865 (66.6%) received chemotherapy alone, radiation therapy alone or combination of both and 2011 (22.9%) received no treatment. Of the 915 patients who had surgery, 65.8% were stage 1, 13.4% stage 2 and 20.8% stage 3. Lobectomy with LN dissection was the most common surgical procedure performed in 424 (46.3%) of the patients, followed by local excision in 193 (21.1%), simple lobectomy in 188 (20.5%) and 64 (6.9%) had pneumonectomy. Surgery was associated with improved median survival across all stages as compared to non-surgical treatments, 45.9 vs 15.9 months in stage 1, 39.4 vs 13.7 months in stage 2 and 21.8 vs 11.5 months in stage 3 (p<0.0001). Of the 915 surgical patients, 561 (61.3%) had surgery only and their median OS was 44.4 months while 354 (38.7%) had surgery followed by adjuvant treatment and their median OS was 32.3 months (p=0.069). Survival was significantly better in those who received chemoradiation following surgery compared to chemoradiation alone (30.9 vs 14.7 months, p<0.0001). Across the entire cohort, median OS was 38.7 months in surgical group and 12.4 months in the non-surgical group (p<0.0001). Age, race, stage, tumor grade, tobacco use and treatment modality are significant variables for survival. Conclusions: Patients with L-SCLC who underwent surgical resection have improved median survival across all stages. Surgery could be potentially considered in early stage patients. However, further prospective trials are warranted to evaluate its role in treatment of L-SCLC.