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The Role of Surgery in Stage I Small Cell Lung Cancer: A National VA Database Analysis
被引:4
|作者:
Azar, Ibrahim
[1
,5
]
Austin, Adam
[2
]
Saha, Biplab K.
[2
]
Kim, Seongho
[1
]
Jang, Hyejeong
[1
]
Al Sbihi, Ali
[1
]
Alkassis, Samer
[1
]
Yazpandanah, Omid
[1
]
Chi, Jie
[1
]
Dhillon, Vikram
[1
]
Mehta, Hiren J.
[2
]
Chopra, Amit
[3
]
Neu, Kristoffer
[4
]
Mehdi, Syed Arzoo
[4
]
Mamdani, Hirva
[1
]
机构:
[1] Wayne State Univ, Karmanos Canc Inst, Sch Med, Dept Oncol, Detroit, MI USA
[2] Univ Florida, Div Pulm Crit Care & Sleep Med, Gainesville, FL USA
[3] Albany Med Coll, Div Pulm & Crit Care Med, Albany, NY USA
[4] Albany Stratton Vet Affairs Med Ctr, Div Pulm & Crit Care Med, Albany, NY USA
[5] Wayne State Univ, Karmanos Canc Inst, 4100 John R, Detroit, MI 48201 USA
关键词:
Veterans;
Thoracic Malignancy;
Cancer Treatment;
Cancer Staging;
Oncology;
INTERNATIONAL-ASSOCIATION;
RADIOTHERAPY;
LOBECTOMY;
D O I:
10.1016/j.cllc.2023.04.002
中图分类号:
R73 [肿瘤学];
学科分类号:
100214 ;
摘要:
The role of surgery in stage I small cell lung cancer (SCLC) is unclear. We conducted a retrospective analysis of 1028 stage I SCLC from National VA Cancer Cube. Surgery-inclusive multimodality treatment was associated with a longer overall survival to chemoradiation, independent of age or performance status. Our study suggests a more expansive role for surgery in stage I SCLC. Background: Historically, limited stage Small Cell Lung Cancer (SCLC) has been treated with concurrent chemoradia-tion (CRT). While current NCCN guidelines recommend consideration of lobectomy in node-negative cT1-T2 SCLC, data regarding the role of surgery in very limited SCLC is lacking. Methods: Data from the National VA Cancer Cube were compiled. A total of 1,028 patients with pathologically confirmed stage I SCLC were studied. Only 661 patients that either received surgery or CRT were included. Interval-censored Weibull and Cox proportional hazard regression models were used to estimate median overall survival (OS) and hazard ratio (HR), respectively. Two survival curves were compared by a Wald test. Subset analysis was performed based on the location of the tumor in the upper vs. lower lobe as delin-eated by ICD-10 codes C34.1 and C34.3. Results: Four-hundred and forty-six patients received concurrent CRT; while 223 underwent treatment that contained surgery (93 surgery only, 87 surgery/chemo, 39 surgery/chemo/radiation and 4 surgery/radiation). The median OS for the surgery-inclusive treatment was 3.87 years (95% CI 3.21-4.48) while median OS for the CRT cohort was 2.45 years (95% CI 2.17-2.74). HR of death for surgery-inclusive treatment when compared to CRT is 0.67 (95% CI 0.55-0.81; P < .001). Subset analysis based on the location of the tumor in both the upper or lower lobes showed improved survival with surgery as compared to CRT regardless of the location. HR for the upper lobe was 0.63 (95% CI 0.50-0.80; P < .001) and lower lobe 0.61 (95% CI 0.42-0.87; P = .006). Multivariable regression analysis accounting for age and ECOG-PS shows a HR 0.60 (95% CI 0.43-0.83; P = .002) favoring surgery. Conclu-sions: Surgery was used in less than a third of patients with stage I SCLC who received treatment. Surgery-inclusive multimodality treatment was associated with a longer overall survival as compared to chemoradiation, independent of age, performance status or tumor location. Our study suggests a more expansive role for surgery in stage I SCLC.
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页码:e179 / e186
页数:8
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