Stage I and II Small-Cell Lung Cancer—New Challenge for Surgery
Fabian Doerr, Sebastian Stange, Maximilian Michel, Georg Schlachtenberger, Hruy Menghesha, Thorsten Wahlers, Khosro Hekmat, Matthias Heldwein
Abstract
PURPOSE: The recommended treatment for small-cell lung cancer (SCLC) currently is surgery in stage I disease. We wondered about stage II SCLC and present a meta-analysis on mean-survival of patients that underwent surgery for stage I and II compared to controls. METHODS: -tests, Q-statistics, DerSimonian-Laird tests and Egger-regression. The meta-analysis was conducted according to PRISMA. RESULTS: Out of 6826 records, seven studies with a total of 11,241 patients ('surgery group': 3911 patients; 'non-surgery group': 7330; treatment period: 1984-2015) were included. Heterogeneity between the studies was revealed in absence of any publication bias. Patient characteristics did not differ between the groups (p-value > 0.05). The mean-survival in an analysis of patients in stage I was 36.7 ± 10.8 months for the 'surgery group' and 20.3 ± 5.7 months for the 'non-surgery group' (p-value = 0.0084). A combined analysis of patients in stage I and II revealed a mean-survival of 32.0 ± 16.7 months for the 'surgery group' and 19.1 ± 6.1 months for the 'non-surgery group' (p-value = 0.0391). In a separate analysis of stage II, we were able to demonstrate a significant survival benefit after surgery (21.4 ± 3.6 versus 16.2 ± 3.9 months; p-value = 0.0493). CONCLUSION: Our meta-analysis shows a significant survival benefit after surgery not only in the recommended stage I but also in stage II SCLC. Our data suggests that both stages should be considered for surgery of early SCLC.