Surveillance Epidemiology and End Results Evaluation of the Role of Surgery for Stage I Small Cell Lung Cancer

Introduction: This study was performed to evaluate the clinical outcomes Of Surgery for stage I small cell lung cancer (SCLC). Methods: The National Cancer Institute Surveillance Epidemiology and End Results (SEER) database was analyzed to evaluate outcomes for patients with SCLC treated from 1988 to 2004. Patients with stage I disease were selected. Kaplan-Meier survival curves were constructed for overall survival (OS) and cause-specific survival for patient strata based on type of surgery and radiation use or nonuse. Although SEER does not provide chemotherapy details, it is assumed that most, if not all, of these patients received systemic therapy. Results: A total of 1560 patients were identified as having stage I SCLC. Median age was 70 years (range 27-94 years). Two hundred forty-seven patients underwent lobectomy, 121 had local tumor excision/ablation, 10 had a pneumonectomy, and surgery was unknown in 21. One thousand one hundred sixty-one did not have any cancer-directed surgery. Of those who had lobectomy, 205 (83%) did not receive radiation therapy (RT), 38 (15%) did receive RT, and use of RT was unknown in 4 (2%). For those who had lobectomy without RT (n = 205), 3- and 5-year OS was 58.1% (95% confidence interval [CI] 51.1-64.5%) and 50.3% (95% Cl 43.1-57.1%), respectively. For those patients who had a lobectomy with RT (n = 38), 3- and 5-year OS was 64.9% (95% Cl 45.5-78.9%) and 57.1% (95% Cl 37.4-72.7%), respectively. Conclusions: Surgery without RT seems to offer reasonable OS outcomes in a cohort of stage I patients who undergo lobectomy. These results should be considered with the understanding that systemic therapy information and margin status are not available from the SEER database.