Jianlong Jia , Lilith Trassl , Fanli Kong , Benteng Deng , Ruonan Liu , Zhengwu Sun , Xiaoyan Lan , Ali Ö. Yildirim , Georgios T. Stathopoulos , Isis E. Fernandez , Andrea C. Schamberger
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Here we investigate the impact of surgery, with special attention to stage III SCLC patients, sub-stages and treatment combinations.</p></div><div><h3>Methods</h3><p>: The overall survival (OS) and cancer-specific survival (CSS) of 33,198 SCLC patients (SEER database) were analyzed retrospectively, using various statistical analyses, including propensity score matching (PSM), recursive partitioning, and sequential landmark analyses.</p></div><div><h3>Results</h3><p>: Independent of stage, the OS of patients with surgery-including treatments was almost always better than without surgery. This holds true for stage I-II patients, even after PMS analysis (<em>p</em> < 0.017). The same was found for stage IV patients that underwent surgery plus chemotherapy vs. chemotherapy alone (<em>p</em> = 0.013 after PSM). Stage III patients showed a robust improvement in OS and CSS after surgery (OS: 18 vs.13 months) or surgery plus chemotherapy (OS: 20 vs.15 months) as confirmed by well-balanced PSM and sequential landmark analyses of long-term survivors. More detailed analyses using two independent approaches showed prolonged OS in T3–4/N0–1 and T1–2/N2 stage III patients after surgery or surgery plus chemotherapy. Importantly, primary site surgery had a major survival advantage over surgery at regional sites (<em>p</em> < 0.003).</p></div><div><h3>Conclusion</h3><p>: Our study demonstrates that selected patients of all stages, including stage III T3–4/N0–1 and T1–2/N2, can benefit greatly from surgery-including treatments. Thus, surgery should be included into hospital treatment recommendations for specifically selected SCLC patients.</p><p>Condensed abstract</p><p>Primary resection in patients with stage III SCLC needs re-evaluation. 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引用次数: 0
摘要
简介小细胞肺癌（SCLC）多为 III-IV 期患者，预后较差。迄今为止，手术还不是治疗任何分期 SCLC 的金标准，也缺乏手术是否有益的证据。在此，我们研究了手术的影响，特别关注 III 期 SCLC 患者、亚分期和治疗组合：回顾性分析了 33198 例 SCLC 患者（SEER 数据库）的总生存期（OS）和癌症特异性生存期（CSS），采用了多种统计分析方法，包括倾向评分匹配（PSM）、递归分区和序列地标分析：与分期无关，接受手术治疗的患者的OS几乎总是优于未接受手术治疗的患者。即使经过 PMS 分析，I-II 期患者的情况也是如此（p < 0.017）。接受手术加化疗与单纯化疗的 IV 期患者的情况也是如此（PSM 分析后，p = 0.013）。III期患者在接受手术（OS：18个月 vs.13 个月）或手术加化疗（OS：20个月 vs.15 个月）后，其OS和CSS均有明显改善，这一点在对长期幸存者进行的均衡PSM和连续地标分析中得到了证实。使用两种独立方法进行的更详细分析显示，T3-4/N0-1 和 T1-2/N2 III 期患者在手术或手术加化疗后的 OS 延长。重要的是，原发部位手术比区域部位手术具有更大的生存优势（p < 0.003）：我们的研究表明，包括T3-4/N0-1期和T1-2/N2期在内的所有分期的选定患者都能从手术治疗中获益匪浅。因此，应将手术纳入医院对特选 SCLC 患者的治疗建议中。部分III期SCLC患者可从手术中明显获益。T3-4/N0-1和T1-2/N2 III期SCLC患者应考虑手术治疗。
Improved survival of patients with stage III small-cell lung cancer with primary resection: A SEER-based analysis
Introduction
: Small cell lung cancer (SCLC) is mostly diagnosed in stage III-IV patients and associated with poor prognosis. To date, surgery is no gold-standard treatment for any SCLC stage and evidence is lacking whether it is beneficial. Here we investigate the impact of surgery, with special attention to stage III SCLC patients, sub-stages and treatment combinations.
Methods
: The overall survival (OS) and cancer-specific survival (CSS) of 33,198 SCLC patients (SEER database) were analyzed retrospectively, using various statistical analyses, including propensity score matching (PSM), recursive partitioning, and sequential landmark analyses.
Results
: Independent of stage, the OS of patients with surgery-including treatments was almost always better than without surgery. This holds true for stage I-II patients, even after PMS analysis (p < 0.017). The same was found for stage IV patients that underwent surgery plus chemotherapy vs. chemotherapy alone (p = 0.013 after PSM). Stage III patients showed a robust improvement in OS and CSS after surgery (OS: 18 vs.13 months) or surgery plus chemotherapy (OS: 20 vs.15 months) as confirmed by well-balanced PSM and sequential landmark analyses of long-term survivors. More detailed analyses using two independent approaches showed prolonged OS in T3–4/N0–1 and T1–2/N2 stage III patients after surgery or surgery plus chemotherapy. Importantly, primary site surgery had a major survival advantage over surgery at regional sites (p < 0.003).
Conclusion
: Our study demonstrates that selected patients of all stages, including stage III T3–4/N0–1 and T1–2/N2, can benefit greatly from surgery-including treatments. Thus, surgery should be included into hospital treatment recommendations for specifically selected SCLC patients.
Condensed abstract
Primary resection in patients with stage III SCLC needs re-evaluation. Selected patients with stage III SCLC benefit significantly from surgery. Patients with T3–4/N0–1 and T1–2/N2 stage III SCLC should be considered for surgery.
期刊介绍：
Translational Oncology publishes the results of novel research investigations which bridge the laboratory and clinical settings including risk assessment, cellular and molecular characterization, prevention, detection, diagnosis and treatment of human cancers with the overall goal of improving the clinical care of oncology patients. Translational Oncology will publish laboratory studies of novel therapeutic interventions as well as clinical trials which evaluate new treatment paradigms for cancer. Peer reviewed manuscript types include Original Reports, Reviews and Editorials.
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