Utilization of Surgery and Its Impact on Survival in Patients With Early Stage Small-cell Lung Cancer in the United States.

Autor: Uprety D; Department of Medical Oncology, Gundersen Health System, La Crosse, WI. Electronic address: upretydipesh@gmail.com., Arjyal L; Department of Medical Oncology, Gundersen Health System, La Crosse, WI., Vallatharasu Y; Department of Medical Oncology, Gundersen Health System, La Crosse, WI., Bista A; Department of Medical Oncology, Gundersen Health System, La Crosse, WI., Borgert A; Department of Medical Research, Gundersen Health System, La Crosse, WI., Fitzsimmons AJ; Department of Medical Research, Gundersen Health System, La Crosse, WI., Parsons BM; Department of Medical Oncology, Gundersen Health System, La Crosse, WI.
Jazyk: angličtina
Zdroj: Clinical lung cancer [Clin Lung Cancer] 2020 Mar; Vol. 21 (2), pp. 186-193.e2. Date of Electronic Publication: 2019 Aug 02.
DOI: 10.1016/j.cllc.2019.07.013
Abstrakt: Introduction: For patients with T1 or T2 N0 M0 small-cell lung cancer (SCLC), lobectomy followed by chemotherapy is the standard of care. However, because of its tendency for early dissemination, patients are often treated with concurrent chemo-radiation without surgery. This study was conducted to evaluate the utilization of surgery and its impact on survival in patients with early stage SCLC.
Materials and Methods: The National Cancer Database was queried to identify patients with T1 or T2 N0 M0 SCLC diagnosed from 2004 to 2013. Multivariate logistic regression modeling was utilized to identify factors associated with receipt of surgery. Patients were stratified into 3 groups: chemo-radiation, surgery followed by chemotherapy, and surgery followed by chemotherapy and prophylactic cranial irradiation (PCI). Kaplan-Meier estimators and Cox proportional-hazards regression were used to compare overall survival. Patients were matched on the propensity score.
Results: A total of 3879 SCLC cases were identified. Of those cases, 80.7% received chemo-radiation. Surgery followed by chemotherapy with or without PCI was associated with better median overall survival (93.0 months [lower 95% confidence interval (CI), 72.5] and 61.7 months [95% CI, 51.8-76.5], respectively) compared with chemo-radiation (31.2 months [95% CI, 26.3-37.0]). PCI offered survival benefit in addition to surgery and chemotherapy (hazard ratio, 0.75).
Conclusions: Our study showed a significant survival benefit with surgery (lobectomy or more), adjuvant chemotherapy, and PCI in patients with T1-T2 N0 M0 SCLC.
(Copyright © 2019 Elsevier Inc. All rights reserved.)
Databáze: MEDLINE
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