The role of surgery in stage I to III small cell lung cancer: A systematic review and meta-analysis.

• Main Authors: Tingting Liu, Zihao Chen, Jun Dang, Guang Li
• Format: Article
• Language: English
• Published: Public Library of Science (PLoS) 2018-01-01
• Series: PLoS ONE
• Online Access: https://doi.org/10.1371/journal.pone.0210001

<h4>Background</h4>The role of surgery in treating small cell lung cancer (SCLC) remains controversial. This meta-analysis aims to determine whether surgical-based treatment improves survival in comparison to radiotherapy, chemotherapy, and chemoradiotherapy for stage I to III SCLC.<h4>Methods</h4>PubMed, PubMed Central, EMBASE, Web of Science, and Cochrane Library were searched for relevant articles. The main outcome were overall survival (OS), reported as hazard ratios (HRs), and 95% confidence intervals (CIs).<h4>Results</h4>Two randomized control trials (RCTs) and 13 retrospective studies that included a total of 41,483 patients were eligible. Surgical resection significantly improved OS when compared to non-surgical treatment in retrospective studies (HR = 0.56, 95% CI: 0.49-0.64, P < 0.001), but not in the 2 "older" RCTs (HR = 0.77, 95% CI: 0.32-1.84, P = 0.55). In the subgroup analysis for retrospective studies, surgical resection was associated with superior OS in stage I (HR = 0.56, 95% CI: 0.49-0.64, P < 0.001), stage II (HR = 0.75, 95% CI: 0.57-0.99, P = 0.04), and stage III diseases (HR = 0.70, 95% CI: 0.56-0.88, P = 0.002). Sublobar resection resulted in worse OS than a lobectomy (HR = 0.64, 95% CI: 0.56-0.74, P < 0.001) for patients undergoing surgical resection.<h4>Conclusions</h4>Surgery-based multi-modality treatment appears to be associated with a favorable survival advantage in stage I and selected stage II to III SCLC. Lobectomy is likely to provide superior OS when compared to sublobar resection. Further prospective RCTs are needed to confirm these findings.