Survival of patients with small cell lung cancer undergoing lung resection in England, 1998-2009
Author(s)
Type
Journal Article
Abstract
Introduction
Chemotherapy or chemoradiotherapy is
the recommended treatment for small cell lung cancer
(SCLC), except in stage I disease where clinical
guidelines state there may be a role for surgery based on
favourable outcomes in case series. Evidence supporting
adjuvant chemotherapy in resected SCLC is limited but
this is widely offered.
Methods
Data on 359 873 patients who were
diagnosed with a
fi
rst primary lung cancer in England
between 1998 and 2009 were grouped according to
histology (SCLC or non-SCLC (NSCLC)) and whether they
underwent a surgical resection. We explored their
survival using Kaplan
–
Meier analysis and Cox regression,
adjusting for age, sex, comorbidity and socioeconomic
status.
Results
The survival of 465 patients with resected
SCLC was lower than patients with resected NSCLC
(5-year survival 31% and 45%, respectively), but much
higher than patients of either group who were not
resected (3%). The difference between resected SCLC
and NSCLC diminished with time after surgery. Survival
was superior for the subgroup of 198
‘
elective
’
SCLC
cases where the diagnosis was most likely known before
resection than for the subgroup of 267
‘
incidental
’
cases
where the SCLC diagnosis was likely to have been made
after resection.
Conclusions
These data serve as a natural experiment
testing the survival after surgical management of SCLC
according to NSCLC principles. Patients with SCLC
treated surgically for early stage disease may have
survival outcomes that approach those of NSCLC,
supporting the emerging clinical practice of offering
surgical resection to selected patients with SCLC.
Chemotherapy or chemoradiotherapy is
the recommended treatment for small cell lung cancer
(SCLC), except in stage I disease where clinical
guidelines state there may be a role for surgery based on
favourable outcomes in case series. Evidence supporting
adjuvant chemotherapy in resected SCLC is limited but
this is widely offered.
Methods
Data on 359 873 patients who were
diagnosed with a
fi
rst primary lung cancer in England
between 1998 and 2009 were grouped according to
histology (SCLC or non-SCLC (NSCLC)) and whether they
underwent a surgical resection. We explored their
survival using Kaplan
–
Meier analysis and Cox regression,
adjusting for age, sex, comorbidity and socioeconomic
status.
Results
The survival of 465 patients with resected
SCLC was lower than patients with resected NSCLC
(5-year survival 31% and 45%, respectively), but much
higher than patients of either group who were not
resected (3%). The difference between resected SCLC
and NSCLC diminished with time after surgery. Survival
was superior for the subgroup of 198
‘
elective
’
SCLC
cases where the diagnosis was most likely known before
resection than for the subgroup of 267
‘
incidental
’
cases
where the SCLC diagnosis was likely to have been made
after resection.
Conclusions
These data serve as a natural experiment
testing the survival after surgical management of SCLC
according to NSCLC principles. Patients with SCLC
treated surgically for early stage disease may have
survival outcomes that approach those of NSCLC,
supporting the emerging clinical practice of offering
surgical resection to selected patients with SCLC.
Date Issued
2014-03-01
Date Acceptance
2013-10-08
Citation
Thorax, 2014, 69 (3), pp.269-273
ISSN
1468-3296
Publisher
BMJ Publishing Group
Start Page
269
End Page
273
Journal / Book Title
Thorax
Volume
69
Issue
3
Copyright Statement
© 2014 The Author(s). This is an Open Access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 3.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/3.0/
Identifier
http://gateway.webofknowledge.com/gateway/Gateway.cgi?GWVersion=2&SrcApp=PARTNER_APP&SrcAuth=LinksAMR&KeyUT=WOS:000331338900016&DestLinkType=FullRecord&DestApp=ALL_WOS&UsrCustomerID=1ba7043ffcc86c417c072aa74d649202
Subjects
Science & Technology
Life Sciences & Biomedicine
Respiratory System
SURGICAL RESECTION
SURGERY
CARCINOMA
TRIAL
CHEMOTHERAPY
RADIOTHERAPY
MANAGEMENT
TIME
Publication Status
Published
Date Publish Online
2013-10-30