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Lung cancer
Original article
Survival of patients with small cell lung cancer undergoing lung resection in England, 1998–2009
  1. Margreet Lüchtenborg1,2,
  2. Sharma P Riaz2,
  3. Eric Lim3,
  4. Richard Page4,
  5. David R Baldwin5,
  6. Erik Jakobsen6,
  7. Peter Vedsted7,
  8. Mike Lind8,
  9. Michael D Peake9,
  10. Anders Mellemgaard10,
  11. James Spicer11,
  12. Loic Lang-Lazdunski12,
  13. Henrik Møller1,7
  1. 1Cancer Epidemiology and Population Health, King's Health Partners Cancer Centre, London, UK
  2. 2Public Health England, Knowledge & Intelligence Team, London, UK
  3. 3The Academic Division of Thoracic Surgery, The Royal Brompton Hospital, London, UK
  4. 4Department of Thoracic Surgery, Liverpool Heart and Chest Hospital, Liverpool, UK
  5. 5Respiratory Medicine Unit, Nottingham University Hospitals and University of Nottingham, David Evans Centre, Nottingham City Hospital Campus, Nottingham, UK
  6. 6Department of Thoracic Surgery, The Danish Lung Cancer Registry, Odense University Hospital, Odense, Denmark
  7. 7Department of Public Health and Research Centre for Cancer Diagnosis in Primary Care, Aarhus University, Aarhus, Denmark
  8. 8Queens Centre for Oncology and Haematology, Hull and East Yorkshire NHS Trust, Hull, UK
  9. 9Department of Respiratory Medicine, Glenfield Hospital, Leicester, UK
  10. 10Department of Oncology, Herlev University Hospital, Copenhagen, Denmark
  11. 11Department of Research Oncology, Division of Cancer Studies, King's College London, London, UK
  12. 12Department of Thoracic Surgery, Guy's and St Thomas' NHS Foundation Trust, and Division of Cancer Studies, King's College London, London, UK
  1. Correspondence to Professor Henrik Møller, King's Health Partners Cancer Centre, King's College London, Research Oncology, Bermondsey Wing, 3rd Floor, Guy's Hospital, Great Maze Pond, London SE1 9RT, UK; henrik.moller{at}kcl.ac.uk

Abstract

Introduction Chemotherapy or chemoradiotherapy is the recommended treatment for small cell lung cancer (SCLC), except in stage I disease where clinical guidelines state there may be a role for surgery based on favourable outcomes in case series. Evidence supporting adjuvant chemotherapy in resected SCLC is limited but this is widely offered.

Methods Data on 359 873 patients who were diagnosed with a first primary lung cancer in England between 1998 and 2009 were grouped according to histology (SCLC or non-SCLC (NSCLC)) and whether they underwent a surgical resection. We explored their survival using Kaplan–Meier analysis and Cox regression, adjusting for age, sex, comorbidity and socioeconomic status.

Results The survival of 465 patients with resected SCLC was lower than patients with resected NSCLC (5-year survival 31% and 45%, respectively), but much higher than patients of either group who were not resected (3%). The difference between resected SCLC and NSCLC diminished with time after surgery. Survival was superior for the subgroup of 198 ‘elective’ SCLC cases where the diagnosis was most likely known before resection than for the subgroup of 267 ‘incidental’ cases where the SCLC diagnosis was likely to have been made after resection.

Conclusions These data serve as a natural experiment testing the survival after surgical management of SCLC according to NSCLC principles. Patients with SCLC treated surgically for early stage disease may have survival outcomes that approach those of NSCLC, supporting the emerging clinical practice of offering surgical resection to selected patients with SCLC.

  • Lung Cancer
  • Small Cell Lung Cancer

This is an Open Access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 3.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/3.0/

https://doi.org/10.1136/thoraxjnl-2013-203884

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