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Updated: Jun 18, 2026
Thoracoscopic Extended Right Middle Plus Lower Sleeve Lobectomy for Non-Small-Cell Lung Cancer
Published on: February 27, 2026
Surgery versus radiotherapy after neoadjuvant immunochemotherapy in limited-stage small cell lung cancer
Rui Zou1, Ziyue Zhu1, Xiao Teng1
1Department of Thoracic Surgery, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China.
Background:
The role of surgery in limited-stage small cell lung cancer (LS-SCLC) remains controversial and has traditionally been limited to early-stage disease. This study aimed to evaluate whether neoadjuvant immunochemotherapy (NIC) followed by surgery is associated with survival outcomes compared with definitive radiotherapy in patients with LS-SCLC.
Methods:
We conducted a single-center retrospective cohort study of 64 patients with stage I-IIIB LS-SCLC who received NIC between April 2020 and July 2024. Patients subsequently underwent surgery (n=23) or definitive radiotherapy (n=41) based on multidisciplinary evaluation and patient preference. The primary endpoints were overall survival (OS) and progression-free survival (PFS). Survival was estimated using the Kaplan-Meier method and compared via log-rank tests. Multivariable Cox proportional hazards regression was employed to identify independent predictors of PFS.
Results:
Baseline demographic, clinical, and tumor characteristics were generally comparable between groups. The objective response rate (ORR) to NIC was 91.3% in the surgery group and 85.4% in the radiotherapy group (P=0.70). Median OS was significantly longer in the surgery group (45 vs. 20 months; P=0.048; 2-year OS: 73.9% vs. 40.4%). Median PFS was also significantly prolonged after surgery (30 vs. 9.5 months; P=0.002; 2-year PFS: 55.2% vs. 23.2%). Multivariable analysis confirmed surgical treatment as an independent favorable factor for PFS [hazard ratio (HR): 0.31, 95% confidence interval (CI): 0.15-0.64; P=0.001]. In exploratory subgroup analyses, the PFS benefit appeared most pronounced in patients with stage II-IIIA disease (median: 32.0 vs. 8.1 months; P=0.004).
Conclusions:
In this cohort, NIC followed by surgery was associated with improved survival outcomes compared with radiotherapy. These findings suggest that surgical consolidation after effective systemic induction is a viable strategy for selected patients with LS-SCLC, particularly those with intermediate disease burden, warranting further prospective validation.
