Trends in Surgical Management of Early-stage Small Cell Lung Cancer

Small cell lung cancer (SCLC) represents about 15% of all lung cancer diagnoses and carries a poor prognosis. The goal herein is to elucidate trends, and factors underlying trends, in surgical management of early-stage small cell lung cancer.

We identified patients > 18 years of age diagnosed with American Joint Committee on Cancer clinical stage IA to IIA small cell lung cancer within the National Cancer Database (NCDB). Patients included were diagnosed from 2004 to 2023. The historical era was 2004 to 2018; the modern era was defined as 2019 to 2023. Chi-square tests, multivariable logistic regression, Kaplan-Meier plots, log-rank tests, and Cox proportional hazards model were used as appropriate.

26,374 (6.6%) patients presented at stages IA to IIA. Of these, 7180 (27.2%) underwent surgery. The rate of surgery significantly increased, with only 13.7% of patients receiving surgery in 2004 versus 34.7% in 2023 (P < .001). Of variables underlying receipt of surgery, clinical stage had the largest effect size (IB (0.34 [0.32-0.37]) and IIA (0.20 [0.18-0.22]). In 2004, 43.1% of patients presented at stage IA compared to 78.6% in 2023. Patients receiving surgery demonstrated improved survival in an adjusted model (0.63 [0.58-0.69], P < .001) and after propensity matched analysis (P < .001). Finally, sublobar resection was associated with worse survival (1.33 [1.23-1.45], P < .001).

The rate of surgical management has significantly increased over time. This likely reflects earlier diagnosis of SCLC, which facilitates appropriate surgical management. These data also demonstrate surgical resection is associated with improved survival, as is lobectomy versus a sublobar resection.