Date of Award

January 2015

Document Type

Thesis

Degree Name

Medical Doctor (MD)

Department

Medicine

First Advisor

Anthony W. Kim

Subject Area(s)

Medicine

Abstract

A minority of small cell lung cancer (SCLC) patients present without metastatic disease and are candidates for curative intent resection. However, current therapy for SCLC relies on chemoradiation, and the role of primary surgical resection in these patients remains controversial. This study investigated surgical resection in select cases of SCLC, using a national cohort of approximately 2,500 resected patients.

A retrospective study of SCLC patients in the National Cancer Data Base (NCDB) was performed where patients were clustered for comparison by stage and treatment regimen. Potentially resectable disease was defined as clinical stage T1-3 N0-2, including patients in stages I to IIIA. Survival was estimated by the Kaplan-Meier method and multivariate regression using a Cox proportional hazards model.

Of 33,953 cases of potentially resectable SCLC, 2,484 patients (7%) underwent surgery of the primary site with curative intent. Five-year overall survival for patients after resection were 51%, 25%, and 18% for clinical stages I, II and IIIA, respectively. The addition of surgery to chemotherapy was associated with a decreased hazard ratio (HR) of 0.57 (95% CI 0.47-0.68), independent of age, stage, and comorbidity score. Lobectomy was associated with a 5-year OS of 40% compared to 22% for sublobar resection, and HR for sublobar resections compared to lobectomy was 1.38 (95% CI 1.12-1.71).

In conclusion, patients with stage I, II and IIIA SCLC who underwent surgical resection as part of initial treatment with chemotherapy had improved overall survival compared to patients treated with non-surgical therapy. These findings warrant prospective studies investigating the use of surgery in the multimodality treatment of select SCLC cases.

Comments

This thesis is restricted to Yale network users only. This thesis is permanently embargoed from public release.

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