- Resource Type:
- Presentation
51. Surgery Confers a Survival Advantage in Limited-Stage Small Cell Lung Cancer: A National Analysis
May 6, 2023
Chi-Fu Yang , Invited Discussant , Massachusetts General Hospital
Sara Sakowitz , Abstract Presenter , David Geffen School of Medicine at UCLA
103rd Annual Meeting, the Los Angeles Convention Center, Los Angeles, CA, USA
Los Angeles Convention Center, 408B
Abstract
Objective
Given the systemic nature and often late presentation of the disease, the role of surgical resection in the multimodal management of Small Cell Lung Cancer (SCLC) remains controversial. Using a nationally-representative cohort, this study evaluated the impact of surgical resection on overall survival among limited-stage SCLC patients.
Methods
All limited-stage I-IIA SCLC patients ≥18 years considered eligible for surgical resection according to AJCC guidelines were identified using the 2004-2017 National Cancer Database. Surgery was defined to comprise lobectomy, pneumonectomy, or lung resection. Patients receiving surgical resection constituted the Surgery cohort (others: No Surgery). Cuzick's nonparametric test was used to assess temporal trends in resection rates. Cox proportional hazard modeling was used to evaluate time-adjusted survival, while Kaplan-Meier survival curves were constructed to evaluate unadjusted five-year survival. Nearest-neighbor propensity matching was used to generate a balanced cohort for a risk-adjusted sensitivity analysis.
Results
Of 16,842 stage I-IIA patients, 2,598 (15.4%) underwent surgical resection. The proportion of patients treated with surgical resection increased over the study time-period (2.89 to 11.16%, nptrend< 0.001).
The Surgery cohort was younger (68 vs 70years) and more frequently diagnosed with Stage IA disease (65.6 vs 39.3%, p< 0.001), but presented with a similar mean Charlson comorbidity score (0.66 vs 0.67, p=0.53), relative to No Surgery. Following risk adjustment, surgery was associated with a 44% decrease in relative risk of mortality (AOR 0.56, 95%CI 0.51-0.61). In a subset analysis evaluating impact of resection on outcomes within each stage, similar results were seen. Further, surgical resection was linked to a +16.37 month increase in survival time (95%CI 15.00-17.74). In a propensity-matched sensitivity analysis, surgery remained associated with decreased odds of mortality (AOR 0.47, 95%CI 0.35-0.64).
Conclusion
Using a national cohort, this study demonstrates that surgical resection significantly benefits patient outcomes and should be offered as a mainstay in early SCLC disease management. Although the proportion of patients treated with surgery increased over the study time course, surgical resection remains a distinctly underused approach. Considering the current dismal median survival of these patients, studies evaluating optimal timing of surgery are warranted.
Sara Sakowitz (1), Troy Coaston (1), Syed Shahyan Bakhtiyar (1), Nikhil Chervu (1), Shayan Ebrahimian (1), Brian Shuch (2), Peyman Benharash (2), Sha'shonda Revels (2), (1) UCLA Cardiovascular Outcomes Research Laboratory, Los Angeles, CA, (2) UCLA, Los Angeles, CA
Chi-Fu Yang
Invited Discussant
Dr. Chi-Fu Jeffrey Yang is a thoracic surgeon at Massachusetts General Hospital and an Assistant Professor of Surgery at Harvard Medical School. He received his medical degree at Harvard Medical School. He completed his general surgery residency at Duke University and cardiothoracic surgery fellowship at Stanford University Medical Center.
Dr. Yang practices all aspects of thoracic surgery. He specializes in minimally invasive techniques, including using VATS and robotic approaches. Dr. Yang has received numerous awards, including recognition for exceptional accomplishment in both clinical care and in teaching. In 2021, he received the Harvard Medical School Charles McCabe Faculty Prize for Excellence in Teaching.
Dr. Yang’s research focus is in the field of thoracic oncology and he performs clinical research. He is the recipient of the 2021 AATS Foundation Surgical Investigator Award. Dr. Yang has been the lead or senior author on several high impact papers published in the Journal of Clinical Oncology, Lancet Respiratory Medicine, Journal of Thoracic Oncology, Annals of Surgery, and Chest. He has written over 100 publications, including over 60 as first-, co-first or senior author. Dr. Yang is an editorial board member of the Journal of Thoracic and Cardiovascular Surgery, the Journal of Thoracic Diseases, and the Society of Thoracic Surgeons Online Curriculum.
Dr. Yang is also focused on raising awareness of lung cancer screening. He started the American Lung Cancer Screening Initiative, a 501(c)(3) non-profit, which has worked with communities across 50 states to highlight the importance of lung cancer screening. In 2020 and 2021, he co-drafted resolutions, S. Res. 780 and S. Res. 426, to raise awareness for lung cancer and lung cancer screening that passed in the U.S. Senate, by unanimous support from all 100 U.S. Senators. In 2021, he received the Harvard Medical School Dean's Community Service Faculty Award in recognition of his efforts.
Sara Sakowitz
Abstract Presenter
Sara is a MS3 at the David Geffen School of Medicine at UCLA.