Advertisement

Pathological Stage N1 Limited-Stage Small-Cell Lung Cancer Patients Can Benefit From Surgical Resection

  • Lian Yu
    Affiliations
    Department of Pulmonary Medicine, Shanghai Chest Hospital, Shanghai Jiaotong University, Shanghai, 200030, China
    Search for articles by this author
  • Jianlin Xu
    Affiliations
    Department of Pulmonary Medicine, Shanghai Chest Hospital, Shanghai Jiaotong University, Shanghai, 200030, China
    Search for articles by this author
  • Rong Qiao
    Affiliations
    Department of Pulmonary Medicine, Shanghai Chest Hospital, Shanghai Jiaotong University, Shanghai, 200030, China
    Search for articles by this author
  • Baohui Han
    Affiliations
    Department of Pulmonary Medicine, Shanghai Chest Hospital, Shanghai Jiaotong University, Shanghai, 200030, China
    Search for articles by this author
  • Hua Zhong MD
    Correspondence
    Address for correspondence: Hua Zhong and Runbo Zhong, Department of Pulmonary Medicine, Shanghai Chest Hospital, Shanghai Jiao Tong University, Huaihai West Road No.241, Shanghai, 200030, China
    Affiliations
    Department of Pulmonary Medicine, Shanghai Chest Hospital, Shanghai Jiaotong University, Shanghai, 200030, China
    Search for articles by this author
  • Runbo Zhong MD
    Correspondence
    Address for correspondence: Hua Zhong and Runbo Zhong, Department of Pulmonary Medicine, Shanghai Chest Hospital, Shanghai Jiao Tong University, Huaihai West Road No.241, Shanghai, 200030, China
    Affiliations
    Department of Pulmonary Medicine, Shanghai Chest Hospital, Shanghai Jiaotong University, Shanghai, 200030, China
    Search for articles by this author
Published:August 14, 2022DOI:https://doi.org/10.1016/j.cllc.2022.08.006

      Abstract

      Purpose

      Surgery is controversial in limited-stage small-cell lung cancer (LS-SCLC) (except for T1-2, N0M0). This study aimed to analyze the survival of LS-SCLC patients with proximal lobe (N1) lymph node metastases after surgery and appropriate postoperative adjuvant treatment.

      Patients and Methods

      We reviewed and followed up medical history and survival data of LS-SCLC patients from June 2007 to June 2016, and a total of 68 pathological stage N1 (p-N1) patients who underwent surgical resection and 71 clinical-stage N1 (c-N1) patients who received chemoradiotherapy were included in the final analysis.

      Results

      The median follow-up of all the patients was 99.30 months. The median disease-free survival (DFS) of the surgery group was 13.567 months, and the median overall survival (OS) of the surgery and chemoradiotherapy groups were 29.600 months and 21.133 months (P-value < .001), respectively. The 2- and 5-year survival rates of the surgery group were 55.9% and 33.7%, and the 2- and 5-year survival rates of the chemoradiotherapy group were 39.8% and 9.4%, respectively. Meanwhile, postoperative thoracic radiotherapy appeared to be associated with a good prognosis (median OS 36.400 vs. 21.333 months, P-value .048), as did prophylactic cranial irradiation (median OS 50.867 vs. 22.600 months, P-value .007) in the surgery group.

      Conclusions

      Surgery may benefit patients with p-N1 SCLC, and in combination with appropriate postoperative adjuvant treatment, surgery may be a new therapeutic modality for SCLC.

      Keywords

      Abbreviations:

      SCLC (small-cell lung cancer), LS (limited-stage), p-N1 (pathological stage N1), c-N1 (clinical-stage N1), TNM (tumor-node-metastasis), AJCC (the American Joint Committee on Cancer), DFS (disease-free survival), OS (overall survival), c-ⅡB (clinical-stage ⅡB), EP/EC (etoposide + cisplatin/carboplatin), TRT (thoracic radiation therapy), PCI (prophylactic cranial irradiation), CI (confidence interval), 3-year LRR rate (3-year local-regional recurrence rate), SEER (Surveillance, Epidemiology, and End Results), MRI (magnetic resonance imaging)
      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'

      Subscribe:

      Subscribe to Clinical Lung Cancer
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect

      References

        • Siegel RL
        • Miller KD
        • Fuchs HE
        • Jemal A.
        Cancer Statistics, 2021.
        CA Cancer J Clin. 2021; 71: 7-33
        • Gazdar AF
        • Bunn PA
        • Minna JD.
        Small-cell lung cancer: what we know, what we need to know and the path forward.
        Nat Rev Cancer. 2017; 17: 725-737
        • Rudin CM
        • Brambilla E
        • Faivre-Finn C
        • Sage J.
        Small-cell lung cancer.
        Nat Rev Dis Primers. 2021; 7: 3
        • Byers LA
        • Rudin CM.
        Small cell lung cancer: where do we go from here?.
        Cancer. 2015; 121: 664-672
        • Pietanza MC
        • Byers LA
        • Minna JD
        • Rudin CM.
        Small cell lung cancer: will recent progress lead to improved outcomes?.
        Clin Cancer Res. 2015; 21: 2244-2255
        • Simon GR
        • Turrisi A
        • American College of Chest P.
        Management of small cell lung cancer: ACCP Evidence-Based Clinical Practice Guidelines (2nd edition).
        Chest. 2007; 132: 324S-339S
        • Fox W
        • Scadding JG.
        Medical research council comparative trial of surgery and radiotherapy for primary treatment of small-celled or oat-celled carcinoma of bronchus.
        Lancet. 1973; 302: 63-65
        • Lad T
        • Piantadosi S
        • Thomas P
        • Payne D
        • Ruckdeschel J
        • Giaccone G.
        A prospective randomized trial to determine the benefit of surgical resection of residual disease following response of small cell lung cancer to combination chemotherapy.
        Chest. 1994; 106: 320S-323S
        • Yao Y
        • Zhou Y
        • Yang Z
        • Huang H
        • Shen H.
        Adjuvant chemotherapy following surgical resection improves survival in patients with early stage small cell lung cancer.
        Oncol Res. 2019; 27: 203-210
        • Che K
        • Shen H
        • Qu X
        • et al.
        Survival outcomes for patients with surgical and non-surgical treatments in stages I-III small-cell lung cancer.
        J Cancer. 2018; 9: 1421-1429
        • Zhao X
        • Kallakury B
        • Chahine JJ
        • et al.
        Surgical resection of SCLC: prognostic factors and the tumor microenvironment.
        J Thorac Oncol. 2019; 14: 914-923
        • Combs SE
        • Hancock JG
        • Boffa DJ
        • Decker RH
        • Detterbeck FC
        • Kim AW.
        Bolstering the case for lobectomy in stages I, II, and IIIA small-cell lung cancer using the National Cancer Data Base.
        J Thorac Oncol. 2015; 10: 316-323
        • Yu L
        • Xu J
        • Qiao R
        • Zhong H
        • Han B
        • Zhong R.
        Patterns of recurrence and survival rate after complete resection of pathological stage N2 small-cell lung cancer.
        Front Oncol. 2021; 11675354
        • Sundstrom S
        • Bremnes RM
        • Kaasa S
        • et al.
        Cisplatin and etoposide regimen is superior to cyclophosphamide, epirubicin, and vincristine regimen in small-cell lung cancer: results from a randomized phase III trial with 5 years' follow-up.
        J Clin Oncol. 2002; 20: 4665-4672
        • Takada M
        • Fukuoka M
        • Kawahara M
        • et al.
        Phase III study of concurrent versus sequential thoracic radiotherapy in combination with cisplatin and etoposide for limited-stage small-cell lung cancer: results of the Japan Clinical Oncology Group Study 9104.
        J Clin Oncol. 2002; 20: 3054-3060
        • Faivre-Finn C
        • Snee M
        • Ashcroft L
        • et al.
        Concurrent once-daily versus twice-daily chemoradiotherapy in patients with limited-stage small-cell lung cancer (CONVERT): an open-label, phase 3, randomised, superiority trial.
        Lancet Oncol. 2017; 18: 1116-1125
        • Tada T
        • Minakuchi K
        • Koda M
        • et al.
        Limited-stage small cell lung cancer: local failure after chemotherapy and radiation therapy.
        Radiology. 1998; 208: 511-515
        • Yang CJ
        • Chan DY
        • Speicher PJ
        • et al.
        Surgery versus optimal medical management for N1 small cell lung cancer.
        Ann Thorac Surg. 2017; 103: 1767-1772
        • Yang CF
        • Chan DY
        • Speicher PJ
        • et al.
        Role of adjuvant therapy in a population-based cohort of patients with early-stage small-cell lung cancer.
        J Clin Oncol. 2016; 34: 1057-1064
        • Ernani V
        • Ganti AK.
        Surgery for limited-stage small cell lung cancer: ready for prime-time?.
        J Thorac Dis. 2017; 9: 3576-3578
        • Urushiyama H
        • Jo T
        • Yasunaga H
        • et al.
        Adjuvant chemotherapy versus chemoradiotherapy for small cell lung cancer with lymph node metastasis: a retrospective observational study with use of a national database in Japan.
        BMC Cancer. 2017; 17: 613
        • Liu WS
        • Zhao LJ
        • Wang S
        • et al.
        Benefits of postoperative radiotherapy in multimodality treatment of resected small-cell lung cancer with lymph node metastasis.
        Eur J Surg Oncol. 2014; 40: 1156-1162
        • Xu J
        • Yang H
        • Fu X
        • et al.
        Prophylactic cranial irradiation for patients with surgically resected small cell lung cancer.
        J Thorac Oncol. 2017; 12: 347-353
        • Gong L
        • Wang QI
        • Zhao L
        • Yuan Z
        • Li R
        • Wang P.
        Factors affecting the risk of brain metastasis in small cell lung cancer with surgery: is prophylactic cranial irradiation necessary for stage I-III disease?.
        Int J Radiat Oncol Biol Phys. 2013; 85: 196-200
        • Yang H
        • Al-Hurani MF
        • Xu J
        • et al.
        pN1 but not pN0/N2 predicts survival benefits of prophylactic cranial irradiation in small-cell lung cancer patients after surgery.
        Ann Transl Med. 2021; 9: 562
        • Levy A
        • Le Pechoux C
        • Mistry H
        • et al.
        Prophylactic cranial irradiation for limited-stage small-cell lung cancer patients: secondary findings from the prospective randomized phase 3 CONVERT trial.
        J Thorac Oncol. 2019; 14: 294-297