Analysis of survival time and benefits of postoperative radiotherapy in resected small cell lung cancer patients
Wang Yanyang1, Ding Xiaolong2, Bai Xuehong1, Yu Liang3, He Jinxi3, Zhao Ren1
1Department of Radiation Oncology, Cancer Hospital & General Hospital of Ningxia Medical University, Yinchuan 750004, China; 2Graduate School, Ningxia Medical University, Yinchuan 750004, China; 3Department of Thoracic Surgery, General Hospital of Ningxia Medical University, Yinchuan 750004, China
Abstract：Objective To analyze the survival time, prognostic factors and the value of postoperative thoracic radiotherapy in resected small cell lung cancer (SCLC) patients. Methods Clinic opathological data of SCLC patients who received surgical treatment in Cancer Hospital & General Hospital of Ningxia Medical University from April 2014 to September 2021 were enrolled in this retrospective study. All patients were subject to follow-up. The survival time of SCLC patients was evaluated by Kaplan‐Meier method. Univariate and multivariate analyses of prognostic factors were performed by Cox proportional hazard model. Results A total of 64 patients with SCLC were enrolled in the study. The 5‐year overall survival (OS) rate was 43.5%. Univariate analysis showed that TNM staging (P=0.027), postoperative neutrophil‐lymphocyte ratio (NLR) (P=0.039) and adjuvant thoracic radiotherapy (P=0.041) were the prognostic factors. Multivariate analysis showed that TNM staging (P=0.038) and adjuvant thoracic radiotherapy (P=0.022) were the prognostic factors in patients with SCLC. The 5‐year OS rates of patients with and without adjuvant thoracic radiotherapy were 71.6% and 35.4% (P=0.028), respectively. There was a statistically significant difference in the 5‐year OS rates between pathological stage N2 SCLC patients with or without adjuvant thoracic radiotherapy (75.0% vs. 0%, P=0.030). Conclusions TNM staging and postoperative adjuvant thoracic radiotherapy are prognostic factors in patients with SCLC undergoing surgical treatment. Pathological stage N2 SCLC patients can benefit from adjuvant thoracic radiotherapy.
Wang Yanyang,Ding Xiaolong,Bai Xuehong et al. Analysis of survival time and benefits of postoperative radiotherapy in resected small cell lung cancer patients[J]. Chinese Journal of Radiation Oncology, 2023, 32(3): 201-206.
[1] Tsao MS, Nicholson AG, Maleszewski JJ, et al.Introduction to 2021 WHO classification of thoracic tumors[J]. J Thorac Oncol, 2022,17(1):e1-e4. DOI: 10.1016/j.jtho.2021.09.017. [2] 郑荣寿, 孙可欣, 张思维, 等. 2015年中国恶性肿瘤流行情况分析[J].中华肿瘤杂志,2019,41(1):19-28. DOI: 10.3760/cma.j.issn.0253-3766.2019.01.008. Zheng RS, Sun KX, Zhang SW, et al.Report of cancer epidemiology in China, 2015[J].Chin J Oncol,2019,41(1):19-28. DOI: 10.3760/cma.j.issn.0253-3766.2019.01.008. [3] Toumazis I, Bastani M, Han SS, et al.Risk-based lung cancer screening: a systematic review[J]. Lung Cancer, 2020,147:154-186. DOI: 10.1016/j.lungcan.2020.07.007. [4] Casiraghi M, Sedda G, Del Signore E, et al.Surgery for small cell lung cancer: when and how[J]. Lung Cancer, 2021,152:71-77. DOI: 10.1016/j.lungcan.2020.12.006. [5] Schreiber D, Rineer J, Weedon J, et al.Survival outcomes with the use of surgery in limited-stage small cell lung cancer: should its role be re-evaluated?[J]. Cancer, 2010,116(5):1350-1357. DOI: 10.1002/cncr.24853. [6] Wang YY, Zheng QW, Jia B, et al.Effects of surgery on survival of early-stage patients with SCLC: propensity score analysis and nomogram construction in SEER database[J]. Front Oncol, 2020,10:626. DOI: 10.3389/fonc.2020.00626. [7] Combs SE, Hancock JG, Boffa DJ, et al.Bolstering the case for lobectomy in stages I, II, and IIIA small-cell lung cancer using the national cancer data base[J]. J Thorac Oncol, 2015,10(2):316-323. DOI: 10.1097/JTO.0000000000000402. [8] Yang CJ, Chan DY, Shah SA, et al.Long-term survival after surgery compared with concurrent chemoradiation for node-negative small cell lung cancer[J]. Ann Surg, 2018,268(6):1105-1112. DOI: 10.1097/SLA.0000000000002287. [9] Kalemkerian GP, Loo BW, Akerley W, et al.NCCN guidelines insights: small cell lung cancer, version 2.2018[J]. J Natl Compr Canc Netw, 2018,16(10):1171-1182. DOI: 10.6004/jnccn.2018.0079. [10] Zeng C, Li NN, Li F, et al.Prognostic factors of patients with small cell lung cancer after surgical treatment[J]. Ann Transl Med, 2021,9(14):1146. DOI: 10.21037/atm-21-2912. [11] 陈梦圆, 胡晓, 戚晓芳, 等. 经匹配后放化疗与手术治疗局限期小细胞肺癌预后比较[J].中华放射肿瘤学杂志,2019,28(11):821-825. DOI: 10.3760/cma.j.issn.1004-4221.2019.11.005. Chen MY, Hu X, Qi XF, et al.Comparison of clinical prognosis of chemo-radiotherapy and surgical treatment for patients with limited stage small cell lung cancer after matching[J].Chin J Radiat Oncol,2019,28(11):821-825. DOI: 10.3760/cma.j.issn.1004-4221.2019.11.005. [12] Zhao XL, Kallakury B, Chahine JJ, et al.Surgical resection of SCLC: prognostic factors and the tumor microenvironment[J]. J Thorac Oncol, 2019,14(5):914-923. DOI: 10.1016/j.jtho.2019.01.019. [13] Liu WS, Zhao LJ, Wang S, et al.Benefits of postoperative radiotherapy in multimodality treatment of resected small-cell lung cancer with lymph node metastasis[J]. Eur J Surg Oncol, 2014,40(9):1156-1162. DOI: 10.1016/j.ejso.2014.02.232. [14] Wong AT, Rineer J, Schwartz D, et al.Assessing the impact of postoperative radiation therapy for completely resected limited-stage small cell lung cancer using the national cancer database[J]. J Thorac Oncol, 2016,11(2):242-248. DOI: 10.1016/j.jtho.2015.10.011. [15] Zhang SL, Sun X, Sun L, et al.Benefits of postoperative thoracic radiotherapy for small cell lung cancer subdivided by lymph node stage: a systematic review and meta-analysis[J]. J Thorac Dis, 2017,9(5):1257-1264. DOI: 10.21037/jtd.2017.03.174. [16] Huang LL, Jiang SY, Shi YK.Prognostic significance of baseline neutrophil-lymphocyte ratio in patients with non-small-cell lung cancer: a pooled analysis of open phase III clinical trial data[J]. Future Oncol, 2022,18(14):1679-1689. DOI: 10.2217/fon-2021-1304. [17] Lu Y, Jiang JW, Ren CX.The clinicopathological and prognostic value of the pretreatment neutrophil-to-lymphocyte ratio in small cell lung cancer: a meta-analysis[J]. PLoS One, 2020,15(4):e0230979. DOI: 10.1371/journal.pone.0230979. [18] Lohinai Z, Bonanno L, Aksarin A, et al.Neutrophil-lymphocyte ratio is prognostic in early stage resected small-cell lung cancer[J]. PeerJ, 2019,7:e7232. DOI: 10.7717/peerj.7232.
2023, Vol. 32 
