Long-term Survival After Surgery Compared With Concurrent Chemoradiation for Node-negative Small Cell Lung Cancer

Area of Science:

• Thoracic Oncology
• Surgical Oncology
• Medical Oncology

Background:

• Current guidelines recommend surgery with adjuvant chemotherapy for early-stage small cell lung cancer (SCLC) (cT1-2N0M0).
• Limited evidence exists comparing surgery to optimal medical management for this patient group.
• No prior studies have prospectively or retrospectively evaluated surgery versus concurrent chemoradiation for cT1-2N0M0 SCLC.

Purpose of the Study:

• To compare the survival outcomes of surgery with adjuvant chemotherapy versus concurrent chemoradiation in patients with cT1-2N0M0 SCLC.
• To evaluate the current utilization patterns of these treatment modalities in early-stage SCLC.
• To determine if surgery offers a survival advantage in this patient population.

Main Methods:

• Retrospective analysis of the National Cancer Data Base (2003-2011) for patients with cT1-2N0M0 SCLC.
• Utilized Cox proportional hazards analyses and propensity-score-matched analyses to compare outcomes.
• Conducted subgroup analysis excluding patients with comorbidities to minimize selection bias.

Main Results:

• Surgery with adjuvant chemotherapy was administered to 30% of patients, while 70% received concurrent chemoradiation.
• Propensity-score matching (n=501 per group) demonstrated significantly higher 5-year overall survival (OS) for surgery (47.6%) versus chemoradiation (29.8%) (P < 0.01).
• In a matched subgroup analysis of patients without comorbidities (n=492), surgery also showed improved 5-year OS (49.2% vs 32.5%, P < 0.01).

Conclusions:

• Surgery with adjuvant chemotherapy is associated with improved long-term survival for node-negative SCLC compared to concurrent chemoradiation.
• The findings suggest a significant underuse of surgical intervention in early-stage SCLC.
• An increased role for surgery in the multimodality treatment of cT1-2N0M0 SCLC is supported by these results.