Patients with limited-stage small-cell lung cancer (LS-SCLC) have better outcomes if they undergo surgical resection, according to research presented at the American Association for Thoracic Surgery (AATS) Annual Meeting.

Researchers found that patients with LS-SCLC who underwent surgical resection had higher survival rates at 1 year and 5 years, when compared with patients who did not have surgery.

This study included 12,266 patients from the National Cancer Database who had stage IA-IIA SCLC. A total of 3465 patients underwent surgery (28.3%), and 8801 did not (71.7%).

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The median age was 68 years in the surgery cohort and 71 years in the no-surgery cohort (P <.001). Fifty-seven percent of patients in each cohort were women. Patients in the surgery cohort were less likely to be Black (6% vs 8%; P <.001), more likely to receive treatment at an academic hospital (32% vs 24%; P <.001), and more likely to have stage IA disease (78% vs 70%; P <.001).

Survival rates at 1 year and 5 years were superior among LS-SCLC patients who underwent surgery, and this was true regardless of disease stage.

The 1-year survival rate was 86% for patients who underwent surgery and 58% for those who did not (hazard ratio [HR], 0.24; P <.001). The 5-year survival rate was 31% and 11%, respectively (HR, 0.41, P <.001). The change in restricted mean survival time was 1.13 years. 

In patients with stage IA disease, the 5-year survival rate was 34% in the surgery cohort and 12% in the no-surgery cohort (P <.001). In patients with stage IB disease, the 5-year survival rate was 19% and 6%, respectively (P <.001). In patients with stage IIA disease, the 5-year survival rate was 16% and 7%, respectively (P <.001).  

Factors associated with a reduced likelihood of surgical resection in LS-SCLC were Black race (vs White race; odds ratio [OR], 0.70), Medicaid (vs private insurance; OR, 0.75), and treatment at a community hospital (vs academic hospital; OR, 0.73).

Based on these results, the researchers concluded that, although surgical resection is associated with improved survival in LS-SCLC, surgical resection remains underused, and disparities in use persist.


Sakowitz S, Coaston T, Bakhtiyar SS, et al. Surgery confers a survival advantage in limited-stage small cell lung cancer: A national analysis. AATS 2023. May 6-9, 2023. Abstract 51.