Cancer Res Treat.  2023 Jan;55(1):94-102. 10.4143/crt.2022.290.

The Role of Adjuvant Therapy Following Surgical Resection of Small Cell Lung Cancer: A Multi-Center Study

• Park SY
• Park S
• Lee GD
• Kim HK
• Choi S
• Kim HR
• Kim YH
• Kim DK
• Park SI
• Hong TH
• Choi YS
• Kim J
• Cho JH
• Shim YM
• Zo JI
• Na KJ
• Park IK
• Kang CH
• Kim YT
• Park BJ
• Lee CY
• Lee JG
• Kim DJ
• Paik HC

• KMID: 2537995
• DOI: http://doi.org/10.4143/crt.2022.290

Abstract

Purpose
This multi-center, retrospective study was conducted to evaluate the long-term survival in patients who underwent surgical resection for small cell lung cancer (SCLC) and to identify the benefit of adjuvant therapy following surgery.
Materials and Methods
The data of 213 patients who underwent surgical resection for SCLC at four institutions were retrospectively reviewed. Patients who received neoadjuvant therapy or an incomplete resection were excluded.
Results
The mean patient age was 65.29±8.93 years, and 184 patients (86.4%) were male. Lobectomies and pneumonectomies were performed in 173 patients (81.2%), and 198 (93%) underwent systematic mediastinal lymph node dissections. Overall, 170 patients (79.8%) underwent adjuvant chemotherapy, 42 (19.7%) underwent radiotherapy to the mediastinum, and 23 (10.8%) underwent prophylactic cranial irradiation. The median follow-up period was 31.08 months (interquartile range, 13.79 to 64.52 months). The 5-year overall survival (OS) and disease-free survival were 53.4% and 46.9%, respectively. The 5-year OS significantly improved after adjuvant chemotherapy in all patients (57.4% vs. 40.3%, p=0.007), and the survival benefit of adjuvant chemotherapy was significant in patients with negative node pathology (70.8% vs. 39.7%, p=0.004). Adjuvant radiotherapy did not affect the 5-year OS (54.6% vs. 48.5%, p=0.458). Age (hazard ratio [HR], 1.032; p=0.017), node metastasis (HR, 2.190; p < 0.001), and adjuvant chemotherapy (HR, 0.558; p=0.019) were associated with OS.
Conclusion
Adjuvant chemotherapy after surgical resection in patients with SCLC improved the OS, though adjuvant radiotherapy to the mediastinum did not improve the survival or decrease the locoregional recurrence rate.

Keyword

Small cell lung carcinoma; Adjuvant chemotherapy; Survival

Figure

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  Fig. 1 Overall survival in patients underwent surgical resection. (A) Overall survival in all patients. (B) Overall survival according to the pathologic T category. (C) Overall urvival according to the pathologic N category. (D) Recurrence in all patients.

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  Fig. 2 Overall survival according to the adjuvant chemotherapy (CTx). (A) Overall survival according to adjuvant CTx in all patients. (B) Overall survival in patients with pathologically negative nodes according to adjuvant CTx status. (C) Overall survival in patients with pathologically positive nodes according to adjuvant CTx status. (D) Recurrence according to adjuvant CTx status.

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  Fig. 3 Overall survival according to the adjuvant radiotherapy (RTx). (A) Overall survival of all patients according to adjuvant RTx status. (B) Overall survival in patients with pathologically negative nodes according to adjuvant RTx status. (C) Overall survival in patients with pathologically positive nodes according to adjuvant RTx status. (D) Freedom from locoregional recurrences according to adjuvant RTx status. CTx, chemotherapy.

Reference

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