Efficacy Of Surgery And Prophylactic Cranial Irradiation In Stage ? And ? Small Cell Lung Cancer

Objective : This study aimed to assess the efficacy of surgery in patients with stage II and III SCLC,and evaluate the value of PCI on resected disease.Methods: A total of 269 consecutive patients with stage II-IIIA SCLC were retrospectively reviewed from January 2010 to December 2015.Of these,116 patients received surgical resection,and 153 underwent non-surgical treatment.Resected patients were matched 1:1 with non-surgical patients(n=70 in each group).The Kaplan-Meier method,log-rank test and Cox regression were adopted for survival analysis and identifying prognostic factors.Results: The median follow-up was 30 months.The 1-,3-and 5-year overall survival(OS)for matched patients were 80.0%,44.3% and 31.7% in surgical group,and 80.0%,24.3% and 20.0% in non-surgical group(P=0.009),respectively.Multivariate analysis in matched patients showed that surgery(HR=0.603,95%CI: 0.404-0.900;P=0.013)and PCI(HR=0.637,95%CI: 0.427-0.950,P=0.027)were independent prognostic factors for OS.In subgroup analysis,OS benefit related to surgery was marginal for stage II(P=0.09)and IIIA patients(P=0.061),but was significant for selected stage IIIA patients who received adjuvant chemo-radiation and PCI(P=0.01).PCI was associated with improved OS for non-surgical patients(P=0.036),and stage IIIA of surgical patients(P=0.047).Conclusions: These findings suggest a potential OS benefit of surgery in stages II and IIIA patients,particularly in selected stage IIIA patients who received adjuvant chemo-radiation and PCI.The use of PCI for surgical patients with stage IIIA was associated with improved OS.