Effect of surgery on survival of patients with small-cell lung cancer undiagnosed before resection.

Background: Standards of treatment for limited-stage small-cell lung cancer (SCLC) include chemoradiotherapy. The place of the surgery in this indication is still debated. The objective of this study was to evaluate the overall survival (OS) in patients who underwent surgery for an SCLC undiagnosed before resection in the University Hospital of Nancy, France. Secondarily, the impact of surgery on recurrence-free survival (RFS) was analyzed.

Methods: All the patients who underwent lung resection in the Department of Thoracic Surgery, from 1991 to 2018, and a diagnosis of SCLC after surgery were included. OS and RFS were analyzed according to the resection type, postoperative staging, and lymph node extension.

Results: Sixty-one patients were included. The median OS was higher in patients with lobectomy than those with pneumonectomy (26 [8.4-208.7] vs. 12 [3.4-27.6] months, P < 0.001) in stage I compared to other stages (58 [8.4-208.7] vs. 17 [3.4-83.5] months, P = 0.002), and N0-1 than N2 (25 [3.6-208.7] vs. 15 [3.4-83.5] months, P = 0.01). RFS was also significantly higher after lobectomy than after pneumonectomy (17 [1.6-184.9] vs. 8 [0.5-17.6], P < 0.001), stage I than stages II-III (35 [5-184.9] vs. 11 [0.5-42.4], P < 0.001) and N0-1 compared to N2 (25 [1.6-184.9] vs. 9 [0.5-16.5] months, P = 0.006). In multivariate analysis, the only independent factor influencing the OS was the pneumonectomy (hazard ratios = 3.19; 95% confidence interval [1.46-6.98], P = 0.004).

Conclusion: Surgical resection of stage I SCLC may lead to better OS and RFS. N1 patients should not automatically be excluded from surgery. Lobectomy with regional lymph node resection is the preferable choice of surgery.