Analysis of unexpected small cell lung cancer following surgery as the primary treatment.

Yang, Haitang; Xu, Jianlin; Yao, Feng; Shun-Qing, Liang; Zhao, Heng (2018). Analysis of unexpected small cell lung cancer following surgery as the primary treatment. Journal of cancer research and clinical oncology, 144(12), pp. 2441-2447. Springer 10.1007/s00432-018-2766-6

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PURPOSE Small cell lung cancer (SCLC) is considered a systemic disease and surgery is generally not recommended to treat it. High heterogeneity within the tumor and preoperative diagnostic capabilities can sometimes fail to identify SCLC correctly, leading to a subset of unexpected SCLC patients that are diagnosed only after pulmonary resections. METHODS We retrospectively reviewed the clinical records of patients who were diagnosed as having SCLC only after surgery between 2008 and 2015 at a single institution. RESULTS A total of 125 unexpected SCLC patients were identified, including those with pure (p-SCLC; n = 76, 60.8%) and combined (c-SCLC; n = 49, 39.2%) SCLC. Highly differential diagnoses were observed between pre- and postoperative tissue examinations. Sixty-nine (55.2%) patients with postoperatively pathological-proven SCLC, including 31 with p-SCLC and 38 with c-SCLC, were diagnosed preoperatively with poorly differentiated carcinoma (n = 23), squamous carcinoma (n = 14), adenocarcinoma (n = 10), malignant cells with necrosis (n = 10), large cell carcinoma (n = 8), or carcinoid (n = 4). Also, inconsistencies between the clinical (c-) and pathological (p-) stages were found in this cohort, which were less common in patients with preoperative PET examination than those without (24.4% vs. 43.8%; p = 0.032). Multivariable analyses showed that higher p-stage (hazards ratio (HR) = 1.7349, p = 0.0025), sub-lobar resection (HR = 1.9078, p = 0.0395), and a lack of prophylactic cranial irradiation treatment (PCI, HR = 0.3873, p = 0.0057) were unfavorable prognostic factors for overall survival. CONCLUSION Non-resection approaches reveal an inadequate diagnosis of SCLC. PET examination facilitates the evaluation of the clinical staging of SCLC. For unexpected SCLC undergoing resection, favorable outcomes can be achieved if radical resection and postoperative PCI are performed.

Item Type:

Journal Article (Original Article)

Division/Institute:

04 Faculty of Medicine > Department of Gastro-intestinal, Liver and Lung Disorders (DMLL) > Clinic of Thoracic Surgery
04 Faculty of Medicine > Pre-clinic Human Medicine > BioMedical Research (DBMR) > Forschungsbereich Mu50 > Forschungsgruppe Thoraxchirurgie

Graduate School:

Graduate School for Cellular and Biomedical Sciences (GCB)

UniBE Contributor:

Yang, Haitang and Shun-Qing, Liang

Subjects:

600 Technology > 610 Medicine & health

ISSN:

1432-1335

Publisher:

Springer

Language:

English

Submitter:

Thomas Michael Marti

Date Deposited:

12 Nov 2019 09:06

Last Modified:

12 Nov 2019 09:06

Publisher DOI:

10.1007/s00432-018-2766-6

PubMed ID:

30341687

Uncontrolled Keywords:

Diagnosis Small cell lung carcinoma Stage Surgery Survival

BORIS DOI:

10.7892/boris.134642

URI:

https://boris.unibe.ch/id/eprint/134642

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