Surgery in the treatment of small cell lung cancer

Background. Small cell lung cancer (SCLC) is one of the most aggressive forms of lung tumors. Currently, there are ongoing discussions about the role of surgery in the treatment of patients with SCLC.

The purpose of the study: does surgery improve prognosis in patients with small-cell lung cancer (SCLC)?

Methods. The material for the study was 7549 patients with lung cancer diagnosed in Ugra from 2002 to 2022. 71 SCLC with stage I to III undergoing surgical resection were enrolled. Lobectomy was performed in 49 patients, pneumonectomy in 22. Systematic nodal dissection (SND) was performed in 59 patients (83.1 %).

Results. In stage I, the ten-year overall survival rate was 65.8 %, in stage II – 33.2 %, in stage III – 14.4 % (p=0,001). Remote results of surgical treatment of SCLC had a significant dependence on the state of regional lymph nodes: with N 0, the 10-year OS was 53.1 %, with N 1 the 10-year OS was 30.6 %, with N 2–15.1 % (p=0,003). Ten-year OS with SND was significantly exceeded other dissections on the lymphatic collector to 42.0 %, while with sampling nodal dissection the 10-year OS was only 20.0 % (p=0,028).

Conclusion. Good remote results in patients with stage I and II SCLC indicate the need to include surgery in the complex treatment of patients with SCLC. The optimal volume of surgery is lobectomy with systematic nodal dissection. Surgery can be performed in patients with stage IIIA and IIIB SCLC in case of tumor regression after induction chemoor chemoradiotherapy, as well as in case of life-threatening complications. Prospective studies are required to determine the indications for surgery in this cohort of patients.

1. Miller AB, Fox W, Tall R. Five-year follow-up of the Medical Research Council comparative trial of surgery and radiotherapy for the primary treatment of small-celled or oatcelled carcinoma of the bronchus. Lancet. 1969 Sep 6; 2 (7619): 501–5. DOI: 10.1016/s0140–6736 (69) 90212-8. PMID: 4184834.

2. Trachtenberg A. H., Chissov V. I. Lung cancer: a guide, atlas. Moscow: GEOTAR-Media, 2009. 656 p.

3. Kalemkerian GP, Akerley W, Bogner P et al. National Comprehensive Cancer Network. Small cell lung cancer. J. Natl. Compr. Canc. Netw. 2013 Jan 1; 11 (1): 78–98. DOI: 10.6004/jnccn.2013.0011

4. Yang CJ, Chan DY, Speicher PJ et al. Surgery Versus Optimal Medical Management for N 1 Small Cell Lung Cancer. Ann Thorac Surg. 2017 Jun;103(6):1767–1772. DOI: 10.1016/j.athoracsur.2017.01.043

5. Lei Y, Feng H, Qiang H. et al. Clinical characteristics and prognostic factors of surgically resected combined small cell lung cancer: a retrospective study. Lung Cancer. 2020 Aug; 146: 244–251. DOI: 10.1016/j.lungcan.2020.06.021

6. 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 Nov 2; 60 (5): 1212–1220. DOI: 10.1093/ejcts/ezab287

7. Rudin CM, Ismaila N, Hann CL. et al. Treatment of Small-Cell Lung Cancer: American Society of Clinical Oncology Endorsement of the American College of Chest Physicians Guideline. J. Clin. Oncol. 2015 Dec 1; 33 (34): 4106–11. DOI: 10.1200/JCO.2015.63.7918

8. Takenaka T, Takenoyama M, Inamasu E. et al. Role of surgical resection for patients with limited disease-small cell lung cancer. Lung. Cancer. 2015 Apr; 88 (1): 52–6. DOI: 10.1016/j.lungcan.2015.01.010 23

9. Fong AJ, Reich H, Mirocha J. et al. Disparities and Underutilization of Surgery for Early Stage Small Cell Lung Cancer. Ann. Thorac. Surg. 2024 Jun; 117 (6): 1095–1102. DOI: 10.1016/j.athoracsur.2024.01.012

10. Lucchi M, Mussi A, Fontanini G. et al. Small cell lung carcinoma (SCLC): the angiogenic phenomenon. Eur. J. Cardiothorac Surg. 2002 Jun; 21 (6): 1105–10. DOI: 10.1016/s1010–7940(02)00112-4

11. Aksarin А. А., Ter-Ovanesov М. D. Role of surgery in the treatment of small cell lung carcinoma. Siberian journal of oncology. 2016; 15 (2): 63–68. https://doi.org/10.21294/1814-4861-2016-15-2-63-68

12. Aksarin A. A., Ter-Ovanesov M.D., Kopeyka S. M. Small cell lung cancer: potential of surgery in the treatment. 2019; 20 (1): 6–12.

13. Martucci N, Morabito A, La Rocca A. et al. Surgery in Small-Cell Lung Cancer. Cancers (Basel). 2021 Jan 21; 13 (3): 390. DOI: 10.3390/cancers13030390

14. Doerr F, Stange S, Michel M. et al. Redefining the role of surgery in early small-cell lung cancer. Langenbecks Arch Surg. 2022 Nov; 407 (7): 2663–2671. DOI:10.1007/s00423-022-02631-4

15. Fu Z, Li D, Deng C. et al. Excellent survival of pathological N 0 small cell lung cancer patients following surgery. Eur. J. Med. Res. 2023 Feb 21; 28 (1): 91. DOI: 10.1186/s40001-023-01044-3

16. Zheng Z, Zhu D, Liu L. et al. Survival of small-cell lung cancer patients after surgery: A single-center retrospective cohort study. J. Investig Med. 2023 Dec; 71 (8): 917–928. DOI: 10.1177/10815589231185542

17. Zhou N, Yang L, Zhang B. et al. Lobectomy versus sublobar resection for stage I (T1T2aN 0M0) small cell lung cancer: A SEER population-based propensity score matching analysis. Cancer Med. 2023 Apr; 12 (7): 7923–7931. DOI: 10.1002/cam4.5568

18. Eberhardt W, Stamatis G, Stuschke M. et al. Prognostically orientated multimodality treatment including surgery for selected patients of small-cell lung cancer patients stages IB to IIIB: long-term results of a phase II trial. Br. J. Cancer. 1999; 81 (7): 1206–12. DOI: 10.1038/sj.bjc.6690830

19. Jones CD, Cummings IG, Shipolini AR, McCormack DJ. Does surgery improve prognosis in patients with small-cell lung carcinoma? Interact Cardiovasc Thorac Surg. 2013; 16 (3): 375–80. DOI: 10.1093/icvts/ivs475

20. Ju MH, Kim HR, Kim JB. et al. Surgical outcomes in small cell lung cancer. Korean J. Thorac. Cardiovasc. Surg. 2012; 45 (1): 40–4. DOI: 10.5090/kjtcs.2012.45.1.40

21. Isaka M, Nakagawa K, Ohde Y. et al. A clinicopathological study of peripheral, smallsized high-grade neuroendocrine tumours of the lung: differences between small-cell lung carcinoma and large-cell neuroendocrine carcinoma. Eur. J. Cardiothorac. Surg. 2012; 41 (4): 841–6. DOI: 10.1093/ejcts/ezr132

22. 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 Feb; 195 (1): 107–114. DOI: 10.1007/s00408-016-9954-4

23. Brock MV, Hooker CM, Syphard JE. et al. Surgical resection of limited disease small cell lung cancer in the new era of platinum chemotherapy: Its time has come. J. Thorac. Cardiovasc. Surg. 2005; 129 (1): 64–72. DOI: 10.1016/j.jtcvs.2004.08.022

24. Schreiber D, Rineer J, Weedon J. et al. Survival outcomes with the use of surgery in limited-stage small cell lung cancer: should its role be re-evaluated? Cancer. 2010 Mar 1; 116 (5): 1350–7. DOI: 10.1002/cncr.24853

25. Xu YJ, Zheng H, Gao W. et al. Is neoadjuvant chemotherapy mandatory for limited-disease small-cell lung cancer? Interact Cardiovasc Thorac Surg. 2014 Dec; 19 (6): 887–93. DOI: 10.1093/icvts/ivu262

26. Liu T, Chen Z, Dang J, Li G. The role of surgery in stage I to III small cell lung cancer: A systematic review and meta-analysis. PLoS One. 2018 Dec 31; 13 (12): e0210001. DOI: 10.1371/journal.pone.0210001

27. Yuequan J, Zhi Z, Chenmin X. Surgical Resection for Small Cell Lung Cancer: Pneumonectomy versus Lobectomy. ISRN Surg. 2012; 2012: 101024. DOI: 10.5402/2012/101024

28. Motas N, Manolache V, Scarci M. et al. Salvage Surgery for Small-Cell Lung Cancer-A Literature Review. Cancers (Basel). 2023 Apr 11; 15 (8): 2241. DOI: 10.3390/cancers15082241

29. Yu L, Xu J, Qiao R. et al. Pathological Stage N 1 Limited-Stage Small-Cell Lung Cancer Patients Can Benefit From Surgical Resection. Clin Lung Cancer. 2023 Jan; 24 (1): e1–e8. DOI: 10.1016/j.cllc.2022.08.006

30. Huang Z, Liu Y, Wang S. et al. Surgery for stage IIB-IIIB small cell lung cancer. World J Surg Oncol. 2023 Oct 23; 21 (1): 333. DOI: 10.1186/s12957-023-03196-2

31. Moiseev P. I. Combined treatment of patients with small cell lung cancer using postoperative chemotherapy and preventive brain irradiation. Minsk. Oncological Journal. 2009; 9 (1): 21–25.

32. Liu L, Li R, Peng Y. et al. Surgery vs. radiotherapy in a population-based cohort of elderly patients with early-stage small-cell lung cancer: an IPTW propensity-score analysis. J. Thorac. Dis. 2023 May 30; 15 (5): 2769–2778. DOI: 10.21037/jtd-23-428

33. Fu Z, Li D, Deng C. et al. Excellent survival of pathological N 0 small cell lung cancer patients following surgery. Eur. J. Med. Res. 2023 Feb 21; 28 (1): 91. DOI: 10.1186/s40001-023-01044-3