Journal of Chest Surgery

The Korean Society for Thoracic and Cardiovascular Surgery (대한심장혈관흉부외과학회)
권호 표지
DOI QR코드

DOI QR Code

Clinical Outcomes after Upfront Surgery in Clinical Stage I-IIA Small Cell Lung Cancer

  • Hyeok Sang, Woo (Department of Thoracic and Cardiovascular Surgery, Seoul National University Hospital) ;
  • Jae Won, Song (Center for Lung Cancer, Research Institute and Hospital, National Cancer Center) ;
  • Samina, Park (Department of Thoracic and Cardiovascular Surgery, Seoul National University Hospital) ;
  • In Kyu, Park (Department of Thoracic and Cardiovascular Surgery, Seoul National University Hospital) ;
  • Chang Hyun, Kang (Department of Thoracic and Cardiovascular Surgery, Seoul National University Hospital) ;
  • Young Tae, Kim (Department of Thoracic and Cardiovascular Surgery, Seoul National University Hospital)
  • Received : 2022.08.22
  • Accepted : 2022.10.11
  • Published : 2022.12.05
Download PDF
⟨ Previous Next ⟩

Abstract

Background: Upfront surgery followed by systemic treatment is recommended to treat clinical stage I-IIA small cell lung cancer (SCLC), but data on the clinical outcomes are sparse. Thus, this study evaluated the stage migration and long-term prognosis of surgically treated clinical stage I-IIA SCLC. Methods: We retrospectively reviewed 49 patients with clinical stage I-IIA SCLC who underwent upfront surgery between 2000 and 2020. Additionally, we re-evaluated the TNM (tumor-node-metastasis) staging according to the eighth edition of the American Joint Committee on Cancer staging system for lung cancer. Results: The clinical stages of SCLC were cIA in 75.5%, cIB in 18.4%, and cIIA in 6.1% of patients. A preoperative histologic diagnosis was made in 65.3% of patients. Lobectomy and systematic lymph node dissection were performed in 77.6% and 83.7% of patients, respectively. The pathological stages were pI in 67.3%, pII in 24.5%, pIII in 4.1%, and pIV in 4.1% of patients. The concordance rate between clinical and pathological stages was 44.9%, and the upstaging rate was 49.0%. The 5-year overall survival (OS) rate was 67.8%. No significant difference in OS was found between stages pI and pII. However, the OS for stages pIII/IV was significantly worse than for stages pI/II (p<0.001). Conclusion: In clinical stage I-IIA SCLC, approximately half of the patients were pathologically upstaged, and OS was favorable after upfront surgery, particularly in pI/II patients. The poor prognosis of pIII/IV patients indicates the necessity of intensive preoperative pathologic mediastinal staging.

Keywords

References

  1. Howlader N, Noone AM, Krapcho M, et al. SEER Cancer Statistics Review, 1975-2018. Bethesda (MD): National Cancer Institute; 2021.
  2. Breitling LP, Rinke A, Gress TM. Recent survival trends in highgrade neuroendocrine neoplasms and lung cancer. Neuroendocrinology 2020;110:225-33. https://doi.org/10.1159/000500883
  3. Shepherd FA, Crowley J, Van Houtte P, et al. The International Association for the Study of Lung Cancer lung cancer staging project: proposals regarding the clinical staging of small cell lung cancer in the forthcoming (seventh) edition of the tumor, node, metastasis classification for lung cancer. J Thorac Oncol 2007;2:1067-77. https://doi.org/10.1097/JTO.0b013e31815bdc0d
  4. Amin MB, Edge SB, Greene FL, et al. Lung. In: Amin MB, Edge SB, Greene FL, et al., editors. AJCC cancer staging manual. 8th ed. Cham: Springer; 2017. p. 431-55.
  5. Nicholson AG, Chansky K, Crowley J, et al. The International Association for the Study of Lung Cancer Lung Cancer Staging Project: proposals for the revision of the clinical and pathologic staging of small cell lung cancer in the forthcoming eighth edition of the TNM Classification for Lung Cancer. J Thorac Oncol 2016;11:300-11. https://doi.org/10.1016/j.jtho.2015.10.008
  6. Ettinger DS, Wood DE, Aisner DL, et al. NCCN guidelines insights: non-small cell lung cancer, version 2.2021. J Natl Compr Canc Netw 2021;19:254-66. https://doi.org/10.6004/jnccn.2021.0013
  7. Combs SE, Hancock JG, Boffa DJ, Decker RH, Detterbeck FC, Kim AW. Bolstering the case for lobectomy in stages I, II, and IIIA smallcell lung cancer using the National Cancer Data Base. J Thorac Oncol 2015;10:316-23. https://doi.org/10.1097/JTO.0000000000000402
  8. Takei H, Kondo H, Miyaoka E, et al. Surgery for small cell lung cancer: a retrospective analysis of 243 patients from Japanese Lung Cancer Registry in 2004. J Thorac Oncol 2014;9:1140-5. https://doi.org/10.1097/JTO.0000000000000226
  9. Takenaka T, Takenoyama M, Inamasu E, et al. Role of surgical resection for patients with limited disease-small cell lung cancer. Lung Cancer 2015;88:52-6. https://doi.org/10.1016/j.lungcan.2015.01.010
  10. Yang CJ, Chan DY, Shah SA, et al. Long-term survival after surgery compared with concurrent chemoradiation for node-negative small cell lung cancer. Ann Surg 2018;268:1105-12. https://doi.org/10.1097/SLA.0000000000002287
  11. Shewale JB, Corsini EM, Correa AM, et al. Time trends and predictors of survival in surgically resected early-stage non-small cell lung cancer patients. J Surg Oncol 2020;122:495-505. https://doi.org/10.1002/jso.25966
  12. Thomas DC, Arnold BN, Rosen JE, et al. Defining outcomes of patients with clinical stage I small cell lung cancer upstaged at surgery. Lung Cancer 2017;103:75-81. https://doi.org/10.1016/j.lungcan.2016.11.016
  13. Haruki T, Takagi Y, Kubouchi Y, et al. Comparison between robot-assisted thoracoscopic surgery and video-assisted thoracoscopic surgery for mediastinal and hilar lymph node dissection in lung cancer surgery. Interact Cardiovasc Thorac Surg 2021;33:409-17. https://doi.org/10.1093/icvts/ivab112
  14. Kneuertz PJ, Cheufou DH, D'Souza DM, et al. Propensity-score adjusted comparison of pathologic nodal upstaging by robotic, video-assisted thoracoscopic, and open lobectomy for non-small cell lung cancer. J Thorac Cardiovasc Surg 2019;158:1457-66. https://doi.org/10.1016/j.jtcvs.2019.06.113
  15. Casiraghi M, Sedda G, Del Signore E, et al. Surgery for small cell lung cancer: when and how. Lung Cancer 2021;152:71-7. https://doi.org/10.1016/j.lungcan.2020.12.006
  16. Leuzzi G, Lococo F, Alessandrini G, et al. Prognostic impact of node-spreading pattern in surgically treated small-cell lung cancer: a multicentric analysis. Lung 2017;195:107-14. https://doi.org/10.1007/s00408-016-9954-4
  17. Yang H, Mei T. The prognostic value of lymph node ratio in patients with surgically resected stage I-III small-cell lung cancer: a propensity score matching analysis of the SEER database. Eur J Cardiothorac Surg 2021;60:1212-20. https://doi.org/10.1093/ejcts/ezab287
  18. Leong TL, Loveland PM, Gorelik A, Irving L, Steinfort DP. Preoperative staging by EBUS in cN0/N1 lung cancer: systematic review and meta-analysis. J Bronchology Interv Pulmonol 2019;26:155-65. https://doi.org/10.1097/LBR.0000000000000545
  19. Bott MJ, Patel AP, Crabtree TD, et al. Pathologic upstaging in patients undergoing resection for stage I non-small cell lung cancer: are there modifiable predictors? Ann Thorac Surg 2015;100:2048-53. https://doi.org/10.1016/j.athoracsur.2015.05.100
  20. Lad T, Piantadosi S, Thomas P, Payne D, Ruckdeschel J, Giaccone G. A prospective randomized trial to determine the benefit of surgical resection of residual disease following response of small cell lung cancer to combination chemotherapy. Chest 1994;106(6 Suppl):320S323S. https://doi.org/10.1378/chest.106.6_supplement.320s
  21. Badzio A, Kurowski K, Karnicka-Mlodkowska H, Jassem J. A retrospective comparative study of surgery followed by chemotherapy vs. non-surgical management in limited-disease small cell lung cancer. Eur J Cardiothorac Surg 2004;26:183-8. https://doi.org/10.1016/j.ejcts.2004.04.012
  22. Zhou N, Bott M, Park BJ, et al. Predictors of survival following surgical resection of limited-stage small cell lung cancer. J Thorac Cardiovasc Surg 2021;161:760-71. https://doi.org/10.1016/j.jtcvs.2020.10.148
  23. Patel S, Macdonald OK, Suntharalingam M. Evaluation of the use of prophylactic cranial irradiation in small cell lung cancer. Cancer 2009;115:842-50. https://doi.org/10.1002/cncr.24105
  24. Eze C, Roengvoraphoj O, Niyazi M, et al. Treatment response and prophylactic cranial irradiation are prognostic factors in a real-life limited-disease small-cell lung cancer patient cohort comprehensively staged with cranial magnetic resonance imaging. Clin Lung Cancer 2017;18:e243-9. https://doi.org/10.1016/j.cllc.2016.11.005