Improved Outcomes Reported With Adjuvant Therapy in Patients With Early-Stage SCLC Undergoing Complete Resection


Key Points

  • Adjuvant treatment was associated with improved overall survival vs surgery alone in patients with early-stage SCLC undergoing complete resection, according to an analysis of the National Cancer Data Base.
  • On multivariate analysis, adjuvant chemotherapy and adjuvant chemotherapy plus brain irradiation were independent predictors of improved survival.

Adjuvant chemotherapy and chemotherapy plus prophylactic cranial irradiation were associated with significantly improved survival vs surgery alone in patients with early-stage small cell lung cancer (SCLC) undergoing complete resection, according to an analysis of National Cancer Data Base data reported in the Journal of Clinical Oncology by Yang et al.

Study Details

The study involved data from 1,574 patients with pathologic T1-2N0M0 SCLC treated between 2003 and 2011. Of them, 954 (61%) underwent complete R0 resection; 566 of these patients (59%) received adjuvant therapy, which consisted of chemotherapy alone in 354, chemoradiation in 190 (including 99 who received cranial irradiation), and radiation alone in 22.

Effect of Adjuvant Therapy

The median follow-up for the entire cohort of 954 patients was 43 months. In the entire cohort, median overall survival was 55.6 months, and 5-year survival was 47.4%. Treatment with adjuvant chemotherapy with or without radiation therapy was associated with significant improvements in median overall survival (66.0 vs 42.1 months) and 5-year overall survival (52.7% vs 40.4%; P < .01) compared with no adjuvant therapy.

Multivariate Analysis

Multivariate analysis included the type of adjuvant therapy, type of operation, year of diagnosis, age, sex, race, household income, urban vs nonurban residence, treatment facility type, distance between residence and treatment facility, comorbidity score, and tumor size. On multivariate analysis, treatment with adjuvant chemotherapy (hazard ratio [HR] = 0.78, P = .02) and chemotherapy with brain irradiation (HR = 0.52, P < .01) were associated with improved overall survival vs no adjuvant therapy.

The investigators concluded: “Patients with pT1-2N0M0 SCLC treated with surgical resection alone have worse outcomes than those who undergo resection with adjuvant chemotherapy alone or chemotherapy with cranial irradiation.”

The study was supported by the National Institutes of Health Cardiothoracic Surgical Trials Network and an American College of Surgeons Resident Research Scholarship.

David H. Harpole, MD, of Duke University Medical Center, is the corresponding author of the Journal of Clinical Oncology article.

The content in this post has not been reviewed by the American Society of Clinical Oncology, Inc. (ASCO®) and does not necessarily reflect the ideas and opinions of ASCO®.