Journal
FRONTIERS IN ONCOLOGY
Volume 11, Issue -, Pages -Publisher
FRONTIERS MEDIA SA
DOI: 10.3389/fonc.2021.704517
Keywords
small cell lung cancer (SCLC); adjuvant chemotherapy (ACT); adjuvant chemoradiotherapy (ACRT); overall survival (OS); prognosis
Categories
Funding
- National Natural Science Foundation of China [81930073, 81972171, 81772466]
- Shanghai Municipal Science and Technology Major Project [2017SHZDZX01, VBH1323001/026]
- Shanghai Municipal Key Clinical Specialty Project [SHSLCZDZK02104]
- Shanghai Technology Innovation Action Project [20JC1417200]
- Pilot Project of Fudan University [IDF159045]
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Adjuvant chemotherapy shows survival benefit for patients without pathologic lymph node metastasis, while adjuvant chemoradiotherapy may achieve a significant survival benefit for patients with pathologic lymph node metastasis. Further prospective studies are needed to validate the results.
Background Data on efficacy of adjuvant therapy for surgically resected small cell lung cancer are scant. This study was determined to reveal the survival benefits of different adjuvant treatment modalities for limited-stage small cell lung cancer patients following surgical resection. Methods Data of patients with histologically confirmed small cell lung cancer after surgical resection were collected from November 2006 to June 2019. Survival analyses were calculated by Kaplan-Meier method, with log-rank test to evaluate statistical significance. Prognostic factors were identified by multivariate analysis using cox proportional hazards model. Further survival analysis and cox regression analysis stratified by clinicopathologic features were conducted to evaluate the survival benefits of different adjuvant treatment modalities. Results In total, 153 out of 157 patients were analyzed. Multivariate analysis showed male sex, lymph node metastasis, residual tumor, VPI and non-adjuvant therapy were independently associated with poor prognosis. Subgroup analyses revealed both adjuvant chemotherapy and adjuvant chemoradiotherapy were significantly associated with superior survival for stage pT2-4 (HR=0.176, 95%CI:0.053-0.578, p=0.004; and HR=0.115, 95%CI:0.033-0.405, p=0.001) and pure SCLC patients (HR=0.182, 95%CI:0.067-0.494, p=0.001; and HR=0.181, 95%CI:0.071-0.465, p<0.001). For pN0 patients, adjuvant chemotherapy was associated with better survival (HR=0.219, 95%CI:0.054-0.891, p=0.034), while adjuvant chemoradiotherapy was associated with improved survival for pN+ patients (HR=0.324, 95%CI:0.138-0.760, p=0.010). Conclusions For patients without pathologic lymph node metastasis, there is a survival benefit with adjuvant chemotherapy. However, for patients with pathologic lymph node metastasis, adjuvant chemoradiotherapy might achieve a significant survival benefit. Further prospective studies are needed to validate the results.
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