Survival Outcomes With the Use of Surgery in Limited-Stage Small Cell Lung Cancer Should Its Role Be Re-Evaluated?

BACKGROUND: Although chemotherapy and radiation therapy currently are recommended in limited-stage small cell lung cancer (L-SCLC), several small series have reported favorable survival outcomes in patients who underwent surgical resection. The authors of this report used a US population-based database to determine survival outcomes of patients who underwent surgery. METHODS: The Surveillance, Epidemiology, and End Results (SEER) registry was used to identify patients who were diagnosed with L-SCLC between 1988 and 2002 coded by SEER as localized disease (T1-T2Nx-N0) or regional disease (T3-T4Nx-N0). Kaplan-Meier and Cox regression analyses were used to compare overall survival (OS) for all patients. RESULTS: In total, 14,179 patients were identified, including 863 patients who underwent surgical resection. Surgery was associated more commonly with T1/T2 disease (P <.001). Surgery was associated with improved survival for both localized disease and regional disease with improvements in median survival from 15 months to 42 months (P <.001) and from 12 months to 22 months (P <.001), respectively. Lobectomy was associated with the best outcome (P <.001). Patients with localized disease who underwent lobectomy with had a median survival of 65 months and a 5-year OS rate of 52.6%; whereas patients who had regional disease had a median survival of 25 months and a 5-year OS rate of 31.8%. On multivariate analysis, the benefit of surgery varied in a time-dependant fashion. However, the benefit of lobectomy remained across all time intervals (P =.002). CONCLUSIONS: The use of surgery, and particularly lobectomy, in selected patients with L-SCLC was associated with improved survival outcomes. Future prospective studies should consider the role of surgery as part of the multimodality management of this disease. Cancer 2010;116:1350-7. (C) 2070 American Cancer Society.