Predictors of survival following surgical resection of limited-stage small cell lung cancer |
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Authors: | Nicolas Zhou Matthew Bott Bernard J Park Eric Vallières Candice L Wilshire Kazuhiro Yasufuku Jonathan D Spicer David R Jones Boris Sepesi |
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Institution: | 1. Department of Thoracic and Cardiovascular Surgery, University of Texas MD Anderson Cancer Center, Houston, Tex;2. Thoracic Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY;3. Division of Thoracic Surgery, Swedish Cancer Institute, Seattle, Wash;4. Division of Thoracic Surgery, University Health Network - Toronto General Hospital, Toronto, Ontario, Canada;5. Division of Thoracic and Upper Gastrointestinal Surgery, McGill University Health Centre, Montreal, Québec, Canada;1. Department of Thoracic and Cardiovascular Surgery, University of Texas MD Anderson Cancer Center, Houston, Tex;2. Department of Pathology, University of Texas MD Anderson Cancer Center, Houston, Tex;3. Department of Radiation Oncology, University of Texas MD Anderson Cancer Center, Houston, Tex;4. Department of Gastrointestinal Medical Oncology, University of Texas MD Anderson Cancer Center, Houston, Tex |
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Abstract: | BackgroundAdjuvant chemotherapy, postoperative radiation (PORT), and prophylactic cranial irradiation (PCI) have been individually examined in limited-stage small cell lung cancer (SCLC). There is a paucity of data on the effectiveness of each adjuvant treatment modality when used in combination after surgical resection of SCLC.MethodsData were collected from 5 cancer centers on all patients with limited-stage SCLC who underwent surgical resection between 1986 and 2019. Univariate and multivariable models were conducted to identify predictors of long-term outcomes, focusing on freedom from recurrence and survival benefit of adjuvant chemotherapy, PORT, and PCI.ResultsA total of 164 patients were analyzed. Multivariable Cox regression analysis did not identify any adjuvant therapies to significantly influence recurrence in this cohort. Specifically, PORT was not associated with a significant influence on locoregional recurrence and PCI was not significantly associated with intracranial outcomes. Adjuvant chemotherapy improved survival in all stage I through III disease (hazard ratio, 0.49; 95% confidence interval, 0.29-0.81; P = .005) and even in pathologically node negative patients (hazard ratio, 0.49; 95% confidence interval, 0.27-0.91; P = .024). Although PCI was found to improve survival in univariate analysis, it was not significant in a multivariable model. PORT was not found to affect survival on either univariate or multivariable analysis.ConclusionsThis is among the largest multi-institutional studies on surgically resected limited-stage SCLC. Our results highlight survival benefit of adjuvant chemotherapy, but did not identify a statistically significant influence from mediastinal PORT or PCI in our cohort. Larger prospective studies are needed to determine the benefit of PORT or PCI in a surgically resected limited-stage SCLC population. |
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Keywords: | small cell lung cancer adjuvant chemotherapy adjuvant radiation prophylactic cranial irradiation FFR"} {"#name":"keyword" "$":{"id":"kwrd0040"} "$$":[{"#name":"text" "_":"freedom from recurrence SCLC"} {"#name":"keyword" "$":{"id":"kwrd0050"} "$$":[{"#name":"text" "_":"small cell lung cancer PCI"} {"#name":"keyword" "$":{"id":"kwrd0060"} "$$":[{"#name":"text" "_":"prophylactic cranial irradiation PORT"} {"#name":"keyword" "$":{"id":"kwrd0070"} "$$":[{"#name":"text" "_":"postoperative radiation therapy OS"} {"#name":"keyword" "$":{"id":"kwrd0080"} "$$":[{"#name":"text" "_":"overall survival RFS"} {"#name":"keyword" "$":{"id":"kwrd0090"} "$$":[{"#name":"text" "_":"recurrence-free survival LRR"} {"#name":"keyword" "$":{"id":"kwrd0100"} "$$":[{"#name":"text" "_":"locoregional recurrence |
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