Defining outcomes of patients with clinical stage I small cell lung cancer upstaged at surgery

Daniel C Thomas; Brian N Arnold; Joshua E Rosen; Michelle C Salazar; Justin D Blasberg; Frank C Detterbeck; Daniel J Boffa; Anthony W Kim

doi:10.1016/j.lungcan.2016.11.016

Defining outcomes of patients with clinical stage I small cell lung cancer upstaged at surgery

Lung Cancer. 2017 Jan:103:75-81. doi: 10.1016/j.lungcan.2016.11.016. Epub 2016 Nov 28.

Authors

Daniel C Thomas¹, Brian N Arnold¹, Joshua E Rosen¹, Michelle C Salazar¹, Justin D Blasberg¹, Frank C Detterbeck¹, Daniel J Boffa¹, Anthony W Kim²

Affiliations

¹ Yale University School of Medicine, Department of Surgery, Section of Thoracic Surgery, New Haven, CT, USA.
² Yale University School of Medicine, Department of Surgery, Section of Thoracic Surgery, New Haven, CT, USA. Electronic address: anthony.kim@med.usc.edu.

PMID: 28024700
DOI: 10.1016/j.lungcan.2016.11.016

Abstract

Background: A proportion of patients with clinical stage I small cell lung cancer (SCLC) will be upstaged following surgical resection. The existing data regarding the management of upstaged SCLC patients and guidelines for their treatment remains sparse. The primary objective was to describe the impact of pathologic upstaging following surgical resection.

Methods: The National Cancer Database was queried for patients with clinical stage I SCLC (cT1-2a,N0,M0) who underwent resection with curative intent followed by adjuvant therapy, excluding patients who underwent surgery alone. Clinical and pathologic T, N, and M staging were compared to identify patients that were upstaged.

Results: Four-hundred and seventy-seven patients were identified with clinical stage I SCLC. Pathologic upstaging occurred in 25% (117). Of those upstaged, 30% (35) were due to a higher pathologic T descriptor and 81% (95) were due to the presence of nodal disease. Overall 5-year survival was significantly worse for upstaged patients compared with those patients who remained a pathologically stage I (36% vs 52%, p<0.001). Among patients with positive lymph node involvement, adjuvant chemotherapy and radiation therapy was associated a significantly improved 5-year survival compared to adjuvant chemotherapy alone (20% vs 55%, respectively, p<0.01). The use of adjuvant chemotherapy and radiation therapy in patients with nodal disease after surgical resection was an independent predictor of improved survival (HR 0.36, 95% CI 0.18-0.73, p<0.01).

Conclusions: Pathologic upstaging is common after surgical resection of stage I SCLC, and is associated with significantly inferior survival. These data provide evidence that recommend the use of adjuvant chemotherapy and radiation therapy in the setting of nodal upstaging after resection of clinical stage I SCLC patients.

Keywords: Adjuvant therapy; Outcomes research; Small cell lung carcinoma; Survival analysis; Thoracic oncology; Thoracic surgery.

MeSH terms

Aged
Aged, 80 and over
Carcinoma, Non-Small-Cell Lung / drug therapy
Carcinoma, Non-Small-Cell Lung / pathology
Carcinoma, Non-Small-Cell Lung / radiotherapy
Carcinoma, Non-Small-Cell Lung / surgery*
Chemotherapy, Adjuvant / methods
Combined Modality Therapy
Databases, Factual
Female
Guidelines as Topic
Humans
Lung Neoplasms / drug therapy
Lung Neoplasms / pathology
Lung Neoplasms / radiotherapy
Lung Neoplasms / surgery*
Lymphatic Metastasis / pathology
Male
Middle Aged
Neoplasm Staging / methods*
Outcome Assessment, Health Care
Pneumonectomy
Postoperative Period
Radiotherapy / methods
Small Cell Lung Carcinoma / drug therapy
Small Cell Lung Carcinoma / pathology
Small Cell Lung Carcinoma / radiotherapy
Small Cell Lung Carcinoma / surgery*
Survival Analysis