J Cancer 2019; 10(22):5404-5412. doi:10.7150/jca.31202 This issue

Research Paper

Benefits of surgery in the multimodality treatment of stage IIB-IIIC small cell lung cancer

Yong Yang1,2#, Guangda Yuan2,3#, Cheng Zhan3#, Yiwei Huang3, Mengnan Zhao3, Xiaodong Yang3, Shuai Wang3, Zongwu Lin3, Shiying Zheng1✉, Tao Lu3 ✉, Weigang Guo3✉, Qun Wang3

1. Department of Cardio-Thoracic Surgery, First Affiliated Hospital of Soochow University, Suzhou, Jiangsu Province, China
2. Department of Thoracic Surgery, Suzhou Hospital affiliated to Nanjing Medical University, Suzhou, Jiangsu Province, China
3. Department of Thoracic Surgery, Zhongshan Hospital, Fudan University, Shanghai, China
#Yong Yang, Guangda Yuan and Cheng Zhan contributed equally to this work.

This is an open access article distributed under the terms of the Creative Commons Attribution License (https://creativecommons.org/licenses/by/4.0/). See http://ivyspring.com/terms for full terms and conditions.
Yang Y, Yuan G, Zhan C, Huang Y, Zhao M, Yang X, Wang S, Lin Z, Zheng S, Lu T, Guo W, Wang Q. Benefits of surgery in the multimodality treatment of stage IIB-IIIC small cell lung cancer. J Cancer 2019; 10(22):5404-5412. doi:10.7150/jca.31202. Available from https://www.jcancer.org/v10p5404.htm

File import instruction


Surgery combined with chemotherapy/radiotherapy is recommended for early stage small cell lung cancer (SCLC); however, the role of surgery in the multimodality treatment of advanced disease remains controversial. The clinical data of patients between 2000 and 2015 were obtained from the Surveillance, Epidemiology, and End Results database. The surgery group included 998 patients with stage IIB-IIIC. A matched non-surgery group (n = 2994) was generated by propensity score matching. The Kaplan-Meier method and log-rank tests were used for survival analyses. Univariate and multivariate analyses were used to identify significant prognostic factors. After matching, there were no significant differences between the two groups in race, age, sex, T classification, N classification, TNM stage, marital status, primary sites, and origin record NAACCR Hispanic Identification Algorithm (NHIA). The surgery group showed better overall survival and cancer-specific survival than the non-surgery group. Univariate and multivariate analyses showed that therapy methods, age, sex, T classification, and N classification were independent prognostic predictors for stage IIB-IIIC SCLC (all P < 0.05). Stratified analyses showed that survival outcomes favored surgery in any age groups, men and women, any T classification except T3, and N0-2 but not N3 compared with non-surgical treatment. The survival differences favored surgery in stage IIB and IIIA SCLC, although they were not significant in stage IIB and IIIC SCLC. Therefore, surgery was associated with improved survival in stage IIB and IIIA SCLC, but not in stage IIIB and IIIC SCLC.

Keywords: small cell lung cancer, surgery, non-surgery, propensity score matching, survival