Role of adjuvant therapy in early-stage small-cell lung cancer: comment on a population-based cohort study of patients with early-stage small-cell lung cancer

Small-cell lung cancer (SCLC) is a lethal disease for which there have been only small advances in diagnosis and treatment over the past decade. After a thorough invasive mediastinal stage evaluation, surgical resection is recommended over nonsurgical treatment in patients with clinical stage I SCLC. Although fewer than 5% of patients with SCLC present with stage I disease, the increasing use of computed tomography (CT) and minimally invasive surgery to remove suspicious lung nodules without prior biopsy may increase this percentage in the future. The role of surgery in SCLC has been analyzed using two large population databases. A study of data from 1988 to 2002 in the US SEER database identified 14,179 patients with SCLC, including 863 (6.1%) who underwent surgery (1). Surgery was more commonly performed in patients with T1/T2 disease (P<0.001). Patients who underwent surgery had better survival than those who did not undergo surgery for both localized (median survival, 42 months vs. 15 months, respectively; P<0.001) and regional disease (median survival, 22 months vs. 12 months, respectively; P<0.001). The 5-year overall survival (OS) rates postoperatively were 45% for localized disease and 26% for regional disease. Another comparative study from 1988 to 2004 using the SEER database analyzed patients treated for stage I SCLC (2). Patients who did not undergo surgery (n=51,161) were compared with those who underwent lobectomy (n=5,247, 15.8%), with 15% of patients receiving postoperative irradiation. The routine administration of adjuvant systemic therapy was assumed, but data were unavailable for confirmation. The 5-year OS for patients undergoing lobectomy with and without postoperative irradiation was 57% and 50%, respectively (P=0.9). In contrast, the 5-year OS for patients treated with external beam irradiation alone was 15%. Furthermore, many studies of patients with SCLC who underwent surgical resection reported that approximately 50% of the patients were not suspected of having SCLC prior to resection