The surgical treatment of small cell lung cancer (SCLC) needs re-thinking_Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Authors：

 CHEN Keneng

Department of Thoracic Surgery, Beijing Cancer Hospital, Beijing, 100142, P.R.China;

Corresponding author：

CHEN Keneng, Email: chenkeneng@bjmu.edu.cn

Keywords：

Small cell lung cancer; early stage; surgery

DOI：

10.7507/1007-4848.202109048

Video：

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TNM system should be used in the staging of small cell lung cancer (SCLC), especially in the limited stages of SCLC. Preoperative staging should be strengthened to avoid invalid operation due to insufficient diagnosis. Retrospective studies showed that the efficacy of surgery (+ chemotherapy) in early SCLC is comparable to the outcome of resection for early stage non-small cell lung cancer, which shakes the concept of "chemotherapy/chemoradiotherapy as the main treatment of SCLC". The best operative procedure of SCLC is lobectomy. Sub-lobectomy and pneumonectomy are inferior to that of lobectomy, but still better than chemotherapy/chemo-radiotherapy in terms to long term survival. All these findings need to be confirmed by large sample prospective randomized studies.

Citation： CHEN Keneng. The surgical treatment of small cell lung cancer (SCLC) needs re-thinking. Chinese Journal of Clinical Thoracic and Cardiovascular Surgery, 2021, 28(11): 1261-1266. doi: 10.7507/1007-4848.202109048 Copy

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2.	Combs SE, Hancock JG, Boffa DJ, et al. Bolstering the case for lobectomy in stages Ⅰ, Ⅱ, and ⅢA small-cell lung cancer using the National Cancer Data Base. J Thorac Oncol, 2015, 10(2): 316-323.
3.	Varlotto JM, Recht A, Flickinger JC, et al. Lobectomy leads to optimal survival in early-stage small cell lung cancer: A retrospective analysis. J Thorac Cardiovasc Surg, 2011, 142(3): 538-546.
4.	Aperribay EA, Pérez J, Gastaldo AS, et al. MA12. 03 Prognostic value of clinical staging according to TNM in SCLC patients: A real-world SEER Database analysis. J Thorac Oncol, 2021, 16(3): S177.
5.	Azar I, Austin A, Jang H, et al. MA12. 05 Is there a role for surgery in stage Ⅰ small cell lung cancer? A National VA Database analysis. J Thorac Oncol, 2021, 16(3): S178.
6.	Roof L, Wei W, Tullio K, et al. Impact of socioeconomic disparities on diagnosis and overall survival in small cell lung cancer: A National Cancer Database analysis. J Clin Oncol, 2021, 39(15_suppl): 8515.
7.	Yang CF, Chan DY, Speicher PJ, et al. Role of adjuvant therapy in a population-based cohort of patients with early-stage small-cell lung cancer. J Clin Oncol, 2016, 34(10): 1057-1064.
8.	Yang CJ, Chan DY, Shah SA, et al. Long-term survival after surgery compared with concurrent chemoradiation for node-negative small cell lung cancer. Ann Surg, 2018, 268(6): 1105-1112.
9.	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, 116(5): 1350-1357.
10.	Yu JB, Decker RH, Detterbeck FC, et al. Surveillance epidemiology and end results evaluation of the role of surgery for stage Ⅰ small cell lung cancer. J Thorac Oncol, 2010, 5(2): 215-219.
11.	Weksler B, Nason KS, Shende M, et al. Surgical resection should be considered for stage Ⅰ and Ⅱ small cell carcinoma of the lung. Ann Thorac Surg, 2012, 94(3): 889-893.
12.	陈克能, 王长利. 小细胞肺癌外科治疗的发展史及现状. 程颖, 孙燕, 吴一龙, 主编. 小细胞肺癌. 北京: 人民卫生出版社, 2014. 1087-1688.
13.	Fox W, Scadding JG. Medical Research Council comparative trial of surgery and radiotherapy for primary treatment of small-celled or oat-celled carcinoma of bronchus. Ten-year follow-up. Lancet, 1973, 2(7820): 63-65.
14.	Lad T, Piantadosi S, Thomas P, et al. A prospective randomized trial to determine the benefit of surgical resection of residual disease following response of small cell lung cancer to combination chemotherapy. Chest, 1994, 106(6Suppl): 320S-323S.
15.	范梦颖, 陈克能. 外科治疗小细胞肺癌新观点. 中华胸心血管外科杂志, 2014, 30(7): 428-431.

1. Lüchtenborg M, Riaz SP, Lim E, et al. Survival of patients with small cell lung cancer undergoing lung resection in England, 1998-2009. Thorax, 2014, 69(3): 269-273.
2. Combs SE, Hancock JG, Boffa DJ, et al. Bolstering the case for lobectomy in stages Ⅰ, Ⅱ, and ⅢA small-cell lung cancer using the National Cancer Data Base. J Thorac Oncol, 2015, 10(2): 316-323.
3. Varlotto JM, Recht A, Flickinger JC, et al. Lobectomy leads to optimal survival in early-stage small cell lung cancer: A retrospective analysis. J Thorac Cardiovasc Surg, 2011, 142(3): 538-546.
4. Aperribay EA, Pérez J, Gastaldo AS, et al. MA12. 03 Prognostic value of clinical staging according to TNM in SCLC patients: A real-world SEER Database analysis. J Thorac Oncol, 2021, 16(3): S177.
5. Azar I, Austin A, Jang H, et al. MA12. 05 Is there a role for surgery in stage Ⅰ small cell lung cancer? A National VA Database analysis. J Thorac Oncol, 2021, 16(3): S178.
6. Roof L, Wei W, Tullio K, et al. Impact of socioeconomic disparities on diagnosis and overall survival in small cell lung cancer: A National Cancer Database analysis. J Clin Oncol, 2021, 39(15_suppl): 8515.
7. Yang CF, Chan DY, Speicher PJ, et al. Role of adjuvant therapy in a population-based cohort of patients with early-stage small-cell lung cancer. J Clin Oncol, 2016, 34(10): 1057-1064.
8. Yang CJ, Chan DY, Shah SA, et al. Long-term survival after surgery compared with concurrent chemoradiation for node-negative small cell lung cancer. Ann Surg, 2018, 268(6): 1105-1112.
9. 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, 116(5): 1350-1357.
10. Yu JB, Decker RH, Detterbeck FC, et al. Surveillance epidemiology and end results evaluation of the role of surgery for stage Ⅰ small cell lung cancer. J Thorac Oncol, 2010, 5(2): 215-219.
11. Weksler B, Nason KS, Shende M, et al. Surgical resection should be considered for stage Ⅰ and Ⅱ small cell carcinoma of the lung. Ann Thorac Surg, 2012, 94(3): 889-893.
12. 陈克能, 王长利. 小细胞肺癌外科治疗的发展史及现状. 程颖, 孙燕, 吴一龙, 主编. 小细胞肺癌. 北京: 人民卫生出版社, 2014. 1087-1688.
13. Fox W, Scadding JG. Medical Research Council comparative trial of surgery and radiotherapy for primary treatment of small-celled or oat-celled carcinoma of bronchus. Ten-year follow-up. Lancet, 1973, 2(7820): 63-65.
14. Lad T, Piantadosi S, Thomas P, et al. A prospective randomized trial to determine the benefit of surgical resection of residual disease following response of small cell lung cancer to combination chemotherapy. Chest, 1994, 106(6Suppl): 320S-323S.
15. 范梦颖, 陈克能. 外科治疗小细胞肺癌新观点. 中华胸心血管外科杂志, 2014, 30(7): 428-431.

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Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

The surgical treatment of small cell lung cancer (SCLC) needs re-thinking

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