Jia Jianlong, Trassl Lilith, Kong Fanli, Deng Benteng, Liu Ruonan, Sun Zhengwu, Lan Xiaoyan, Yildirim Ali Ö, Stathopoulos Georgios T, Fernandez Isis E, Schamberger Andrea C
Comprehensive Pneumology Center (CPC), Institute of Lung Health and Immunity (LHI), Helmholtz Zentrum München, Munich, Germany and Member of the German Center for Lung Research (DZL), Germany; Ludwig-Maximilians-University (LMU), Munich, Germany.
Comprehensive Pneumology Center (CPC), Institute of Lung Health and Immunity (LHI), Helmholtz Zentrum München, Munich, Germany and Member of the German Center for Lung Research (DZL), Germany.
Transl Oncol. 2024 Nov;49:102070. doi: 10.1016/j.tranon.2024.102070. Epub 2024 Aug 24.
Small cell lung cancer (SCLC) is mostly diagnosed in stage III-IV patients and associated with poor prognosis. To date, surgery is no gold-standard treatment for any SCLC stage and evidence is lacking whether it is beneficial. Here we investigate the impact of surgery, with special attention to stage III SCLC patients, sub-stages and treatment combinations.
The overall survival (OS) and cancer-specific survival (CSS) of 33,198 SCLC patients (SEER database) were analyzed retrospectively, using various statistical analyses, including propensity score matching (PSM), recursive partitioning, and sequential landmark analyses.
Independent of stage, the OS of patients with surgery-including treatments was almost always better than without surgery. This holds true for stage I-II patients, even after PMS analysis (p < 0.017). The same was found for stage IV patients that underwent surgery plus chemotherapy vs. chemotherapy alone (p = 0.013 after PSM). Stage III patients showed a robust improvement in OS and CSS after surgery (OS: 18 vs.13 months) or surgery plus chemotherapy (OS: 20 vs.15 months) as confirmed by well-balanced PSM and sequential landmark analyses of long-term survivors. More detailed analyses using two independent approaches showed prolonged OS in T3-4/N0-1 and T1-2/N2 stage III patients after surgery or surgery plus chemotherapy. Importantly, primary site surgery had a major survival advantage over surgery at regional sites (p < 0.003).
Our study demonstrates that selected patients of all stages, including stage III T3-4/N0-1 and T1-2/N2, can benefit greatly from surgery-including treatments. Thus, surgery should be included into hospital treatment recommendations for specifically selected SCLC patients. Condensed abstract Primary resection in patients with stage III SCLC needs re-evaluation. Selected patients with stage III SCLC benefit significantly from surgery. Patients with T3-4/N0-1 and T1-2/N2 stage III SCLC should be considered for surgery.
小细胞肺癌（SCLC）大多在III-IV期患者中被诊断出来，且预后较差。迄今为止，手术并非任何SCLC分期的金标准治疗方法，也缺乏其是否有益的证据。在此，我们研究手术的影响，特别关注III期SCLC患者、亚分期和治疗组合。
回顾性分析33198例SCLC患者（SEER数据库）的总生存期（OS）和癌症特异性生存期（CSS），采用多种统计分析方法，包括倾向评分匹配（PSM）、递归划分和序贯地标分析。
无论分期如何，接受包括手术在内治疗的患者的OS几乎总是优于未接受手术的患者。对于I-II期患者，即使经过PMS分析也是如此（p<0.017）。接受手术加化疗的IV期患者与单纯接受化疗的患者相比也有同样的结果（PSM后p=0.013）。通过长期幸存者的均衡PSM和序贯地标分析证实，III期患者在手术后（OS：18个月对13个月）或手术加化疗后（OS：20个月对15个月）的OS和CSS有显著改善。使用两种独立方法进行的更详细分析显示，T3-4/N0-1和T1-2/N2期III期患者在手术后或手术加化疗后的OS延长。重要的是，原发部位手术比区域部位手术具有更大的生存优势（p<0.003）。
我们的研究表明，所有分期的选定患者，包括III期T3-4/N0-1和T1-2/N2患者，都可以从包括手术在内的治疗中大大受益。因此，手术应纳入特定选定SCLC患者的医院治疗建议中。简明摘要III期SCLC患者的原发切除需要重新评估。选定的III期SCLC患者从手术中显著受益。T3-4/N0-1和T1-2/N2期III期SCLC患者应考虑手术治疗。
