Closing the RCT Gap—A Large Meta-Analysis on the Role of Surgery in Stage I–III Small Cell Lung Cancer Patients
by
, , , , ,
Fabian Doerr
1,*
,
Sebastian Stange
2,
Sophie Salamon
3,
Konstantinos Grapatsas
1,
Natalie Baldes
1,
Maximilian Michel
4,
Hruy Menghesha
5,6,
Georg Schlachtenberger
7
,
Matthias B. Heldwein
7,
Lars Hagmeyer
8,
Jürgen Wolf
9,
Eric D. Roessner
10,
Thorsten Wahlers
7,
Martin Schuler
11,12,
Khosro Hekmat
7 and
Servet Bölükbas
1
1
Department of Thoracic Surgery, West German Cancer Center, University Medical Center Essen-Ruhrlandklinik, University Duisburg-Essen, 45239 Essen, Germany
2
Department of Thoracic Surgery, Regiomed-Klinikum Coburg GmbH, 96450 Coburg, Germany
3
Clinic for Oral Surgery, 40879 Ratingen, Germany
4
Institute of Zoology, Faculty of Mathematics and Natural Sciences, University of Cologne, 50674 Cologne, Germany
5
Department of Thoracic Surgery, Helios Clinic Bonn/Rhein-Sieg, 53123 Bonn, Germany
6
Division of Thoracic Surgery, Department of General, Thoracic and Vascular Surgery, Bonn University Hospital, 53127 Bonn, Germany
7
Department of Cardiothoracic Surgery, University Hospital of Cologne, University of Cologne, 50937 Cologne, Germany
8
Clinic for Pneumology and Allergology, Bethanien Hospital GmbH, 42699 Solingen, Germany
9
Lung Cancer Group Cologne, Department I of Internal Medicine, University Hospital Cologne, University of Cologne, 50937 Cologne, Germany
10
Interdisciplinary Thoracic Center, Division of Thoracic Surgery, University Hospital of Mainz, University of Mainz, 55131 Mainz, Germany
11
Department of Medical Oncology, West German Cancer Center, University Medical Center Essen, University Duisburg-Essen, 45147 Essen, Germany
12
National Center for Tumor Diseases (NCT) West, Campus Essen, 45147 Essen, Germany
*
Author to whom correspondence should be addressed.
Cancers 2024, 16(11), 2078; https://doi.org/10.3390/cancers16112078
Submission received: 31 March 2024
/
Revised: 23 May 2024
/
Accepted: 27 May 2024
/
Published: 30 May 2024
(This article belongs to the Section Systematic Review or Meta-Analysis in Cancer Research)
Simple Summary
Despite guidelines recommending surgery as part of treatment for stage I small cell lung cancer (SCLC), its application remains inconsistent, and its role in stages II and III is under debate. In absence of current randomized control trials this meta-analysis compared surgery to non-surgical treatment for stages I to III SCLC. After a systematic review, ten studies with a total of 95,323 patients were analyzed. The analysis found no significant differences in patient characteristics between the surgery and non-surgery groups. The 5-year survival rate for resected patients was significantly higher compared to non-surgically treated patients. This finding was valid also for patients in stages II and III. Surgery might significantly improve survival in SCLC patients and should be considered in treatment planning even in higher stages.
Abstract
Introduction: Despite clear guideline recommendations, surgery is not consistently carried out as part of multimodal therapy in stage I small cell lung cancer (SCLC) patients. The role of surgery in stages II and III is even more controversial. In the absence of current randomized control trials (RCT), we performed a meta-analysis comparing surgery versus non-surgical treatment in stage I to III SCLC patients. Methods: A systematic review of the literature was conducted on 1 July 2023, focusing on studies pertaining to the impact of surgery on small cell lung cancer (SCLC). These studies were evaluated using the ROBINS-I tool. Statistical analyses, including I² tests, Q-statistics, DerSimonian-Laird tests, and Egger regression, were performed to assess the data. In addition, 5-year survival rates were analyzed. The meta-analysis was conducted according to PRISMA standards. Results: Among the 6826 records identified, 10 original studies encompassing a collective cohort of 95,323 patients were incorporated into this meta-analysis. Heterogeneity was observed across the included studies, with no discernible indication of publication bias. Analysis of patient characteristics revealed no significant differences between the two groups (p-value > 0.05). The 5-year survival rates in a combined analysis of patients in stages I–III were 39.6 ± 15.3% for the ‘surgery group’ and 16.7 ± 12.7% for the ‘non-surgery group’ (p-value < 0.0001). SCLC patients in stages II and III treated outside the guideline with surgery had a significantly better 5-year survival compared to non-surgery controls (36.3 ± 20.2% vs. 20.2 ± 17.0%; p-value = 0.043). Conclusions: In the absence of current RCTs, this meta-analysis provides robust suggestions that surgery might significantly improve survival in all SCLC stages. Non-surgical therapy could lead to a shortening of life. The feasibility of surgery in non-metastatic SCLC should always be evaluated as part of a multimodal treatment.
Keywords:
small cell lung cancer; surgery; meta-analysis; 5-year survival
