Reassessing surgical resection in small cell lung cancer in the multimodal treatment era

Small cell lung cancer (SCLC) accounts for approximately 15% of all lung cancer cases. Although up to 30% of patients present with locoregional disease, only a highly selected minority are considered candidates for multimodality treatment including surgical resection.

In this single-center retrospective study, patients with SCLC who underwent surgical resection as part of a multimodality treatment approach between 2000 and 2023 were analyzed. Clinical, pathological, treatment-related variables, and follow-up data were collected. A control cohort of 115 patients treated with definitive chemoradiotherapy (CRT) during the same period was included. Propensity score matching (1:1) was performed based on age, sex, and UICC stage.

A total of 115 patients (70 men, 45 women; median age 62.6 years) underwent surgical resection. Anatomical lung resection with systematic lymph node dissection was performed in 108 patients (93.9%), while 7 patients (6.1%) underwent wedge resection with lymphadenectomy. Platinum-based chemotherapy was administered in 92.2% of patients, and 31.1% received mediastinal radiotherapy. Median overall survival (OS) was significantly longer in the surgical cohort compared with the CRT cohort (57.3 vs. 21.7 months; p < 0.0001). In stage I-II disease, median OS was 88.5 months in the surgical group versus 26.1 months in the CRT group (p < 0.0001). On multivariable analysis, age, sex, tumor stage, and treatment modality were independently associated with OS.

In this retrospective cohort, surgical resection as part of a multimodality treatment strategy was associated with favorable survival outcomes in highly selected patients with early-stage SCLC. Owing to the retrospective study design and the potential for residual selection bias, these findings should be considered hypothesis-generating and warrant prospective validation.