Do patients with cardiovascular diseases have earlier relapse in stage I-III non-small cell lung cancer?

2013 ◽  
Vol 31 (15_suppl) ◽  
pp. 9603-9603
Author(s):  
Robert M. Crescentini ◽  
Richard R. Reich ◽  
Pooja Bardhan ◽  
Martine Extermann
Keyword(s):  
Cerebrovascular Disease ◽  
Cox Regression ◽  
Early Stage ◽  
Antihypertensive Agents ◽  
Disease Free Survival ◽  
Stage I ◽  
Cancer Center ◽  
Bivariate Analysis ◽  
Early Stage Disease ◽  
Kaplan Meier

9603 Background: Diabetes mellitus (DM) has been reported to be an independent risk factor in the development of recurrence of NSCLC following treatment of early stage disease. We evaluated to see if there was a similar effect of cardiovascular disease in patients with newly diagnosed NSCLC. Methods: Using the Moffitt Cancer Center (MCC) databases, patients were identified who were treated for stage I, II and III NSCLC at MCC from 2001-2003. Charts were reviewed and descriptive data were recorded including histories of DM, coronary artery disease (CAD), hypertension, cerebrovascular disease and congestive heart failure (CHF). The use of aspirin and antihypertensive agents at the time of diagnosis were also recorded. Primary endpoint was disease free survival (DFS). Overall survival (OS) was a secondary endpoint. Kaplan Meier curves and Cox regression analyses were used for DFS and OS. Results: A total of707 patients were identified. Ninety-seven patients had DM, 158 had CAD, 396 had hypertension, 43 had cerebrovascular disease and 56 had CHF. DFS was worse in patients with DM (p<0.001, OR 0.63, 95% CI 0.50-0.80), CAD (p<0.001, OR 0.70, 95% CI 0.57-0.85), hypertension (p=0.016, OR 0.81, 95% CI 0.67-0.96), cerebrovascular disease (p=0.006, OR 0.62, 95% CI 0.45-0.87) and CHF (p<0.001, OR 0.56, 95% CI 0.42-0.75). Bivariate analysis showed that CAD, cerebrovascular disease and CHF were associated with shorter DFS independent of DM. OS was also worse in patients with DM (p<0.001, 95% CI 0.50-0.81), CAD (p<0.001, OR 0.62, 95% CI 0.51-0.78), hypertension (p=0.004, OR 0.77, 95% CI 0.64-0.92), cerebrovascular disease (p=0.02, OR 0.66, 95% CI 0.47-0.94) and CHF (p<0.001, OR 0.54, 95% CI 0.41-0.73). In patients with hypertension, there was an improvement in DFS (p=0.047, OR 1.35, 95% CI 1.004-1.819) for those treated with thiazide diuretics. There were no other statistically significant differences in patients based on antihypertensive regimens or aspirin use. Conclusions: DM,CAD, hypertension, cerebrovascular disease and CHF are associated with shorter DFS and worse overall prognosis in patients with non-metastatic NSCLC. CAD, cerebrovascular disease and CHF are associated with shorter DFS independent of DM.

Clinical characteristics, genomic features, and recurrence risk of early-stage MET exon 14 mutant non-small cell lung cancer (NSCLC).

2020 ◽  
Vol 38 (15_suppl) ◽  
pp. 9042-9042
Author(s):  
Gonzalo Recondo ◽  
Robin Guo ◽  
Paola Cravero ◽  
Biagio Ricciuti ◽  
Christina Falcon ◽  
...  
Keyword(s):  
Molecular Subtype ◽  
Early Stage ◽  
Smoking Status ◽  
Disease Free Survival ◽  
Stage I ◽  
Cancer Center ◽  
Early Stage Disease ◽  
Genomic Features ◽  
Metastatic Setting ◽  
Resected Stage

9042 Background: MET exon 14 alterations occur in ~3% of patients (pts) with NSCLC. Although clinical and genomic features of MET exon 14 mutant (mut) NSCLC are better characterized in the metastatic setting, less is known about early-stage disease for this molecular subtype. Methods: Clinicopathologic and genomic data were collected from patients (pts) with resected stage I-III MET exon 14 mutant NSCLC at the Dana-Farber Cancer Institute (DFCI) and the Memorial Sloan Kettering Cancer Center (MSKCC). We estimated the disease-free survival (DFS) and overall survival (OS) of patients from the date of surgical resection. The prevalence of MET exon 14 mutations in stage I-III NSCLC was assessed using OncoPanel NGS v3.0 at DFCI. Results: The prevalence of MET exon 14 alterations in resected tumors of pts with stage I-III NSCLC at DFCI using Oncopanel v3 was 2.8% (17/613) overall: 2.9% (16/542) in non-squamous and 1.4% (1/71) in squamous histology. We identified 131 pts with resected stage I-III (I = 73, II = 28, III = 30) MET exon 14 mut NSCLC at DFCI (Oncopanel v1-v3) and MSKCC (MSK-IMPACT), with a median age of 71 years (yrs) (range: 43-88). There were no significant differences in sex, smoking status, or type of MET alteration across stages. In stage I resected tumors there was a higher proportion of adenocarcinoma histology compared to stages II and III (p = 0.009). The median harmonized TMB (mTMB) was similar across stages (p = 0.43). Common genomic co-alterations included MET amplification (amp) (5.3%), CDK4/ 6 amp (19.1%), MDM2 amp (35.1%), TP53 mut (17.6%) and CDKN2A/ B loss (9.2%). The median DFS in stage I, II, and III NSCLC was 8.3 yrs (95% CI: 3.1-8.3), 2.6 yrs (95% CI: 1.0-2.6), and 2.1 yrs (95% CI: 0.7-2.7), respectively (p = 0.017). The median OS in stage I, II, and III NSCLC was 9.2 yrs (95% CI: 8.5 -10.5), not reached (NR) (95% CI: NR-NR), and 4.1 yrs (95% CI: 3.6-4.1), respectively (p = 0.052). Concurrent MET amp was independently associated with worse DFS (HR: 4.9, 95% CI: 1.8-13.1; p = 0.002) in multivariate analysis. Conclusions: MET exon 14 mutations are present in 2.8% of resected stage I-III NSCLCs. Given the prevalence of this molecular alteration in early-stage NSCLC, clinical trials exploring the role of adjuvant and neoadjuvant MET targeted therapies in this population may be warranted.

Ovarian Yolk Sac Tumor: The Experience of a Regional Cancer Center

2016 ◽  
Vol 26 (5) ◽  
pp. 884-891 ◽  
Author(s):  
Xiaojing Wang ◽  
Zebiao Ma ◽  
Yanfang Li
Keyword(s):  
Prognostic Factor ◽  
Early Stage ◽  
Clinical Stage ◽  
Univariate Analysis ◽  
Yolk Sac ◽  
Stage I ◽  
Yolk Sac Tumor ◽  
Cancer Center ◽  
Significant Prognostic Factor ◽  
Early Stage Disease

ObjectiveThe aim of this study was to evaluate the clinicopathologic characteristics of patients with ovarian yolk sac tumor and the benefit of omentectomy in patients with clinical early-stage disease.MethodsThe medical records of 66 patients with ovarian yolk sac tumor were reviewed retrospectively.ResultsThere were 37, 8, 14, and 7 patients with stages I, II, III, and IV disease, respectively. Sixty-five patients received surgery and adjuvant chemotherapy, and 1 had chemotherapy only. The median follow-up was 78 months. The overall 5-year survival rate was 86.0%. Univariate analysis revealed that stage (P = 0 .022), age (P = 0.001), residual tumor (P = 0.036), and satisfactory α-fetoprotein (AFP) decline (defined as normalization of AFP after the first or second cycles of postsurgery chemotherapy, P = 0.006) were significant prognostic factors. Multivariate analysis revealed that satisfactory AFP decline was an independent significant prognostic factor for overall survival (P = 0.028). The postoperative pathology showed that only 1 (2.7%) of 37 patients who received omentectomy without gross spread had omentum metastasis microscopically. The 5-year survival rates were 89.2% and 100.0% for stage I-II patients with (36 cases) or without (9 cases) omentectomy, respectively (P > 0.05). Three of the 7 patients with recurrence were successfully salvaged and lived 38.0, 102.6, and 45.2 months after initial diagnosis.ConclusionsPostsurgery satisfactory AFP decline was an independent significant prognostic factor for patient survival. Omentectomy might not be of therapeutic significance for clinical stage I-II patients.

Survival outcomes in HER2-positive invasive lobular breast carcinoma.

2012 ◽  
Vol 30 (15_suppl) ◽  
pp. 612-612
Author(s):  
Carlos Hernando Barcenas ◽  
Kenneth R. Hess ◽  
Yann Delpech ◽  
Lajos Pusztai ◽  
Gabriel N. Hortobagyi ◽  
...  
Keyword(s):  
Breast Carcinoma ◽  
Triple Negative ◽  
Early Stage ◽  
Disease Free Survival ◽  
Stage I ◽  
Cancer Center ◽  
Survival Outcomes ◽  
Her2 Positive ◽  
Number Of Patients ◽  
Lobular Breast Carcinoma

612 Background: HER2-positive (HER2+) invasive lobular breast carcinoma (ILC) is a rare entity and survival outcomes are not well characterized. Methods: We retrospectively searched for breast cancer patients treated at MD Anderson Cancer Center between 1992 and 2010 with a diagnosis of early stage (I-III) HER2+ILC or with HER2+ invasive mixed ductal/lobular carcinoma (MIX). With the purpose of comparing survival outcomes, we looked for patients with a diagnosis of HER2-negative [HER2(-)] ILC, HER2(-)MIX, and HER2+ invasive ductal carcinomas (IDC). We obtained data on demographics, estrogen (ER) and progesterone (PR) receptor status, tumor grade, chemotherapy received and survival status. A multivariate analysis using a Cox proportional hazards regression was performed to compare disease-free survival (DFS) and overall survival (OS) between the following groups: 1) HER2+ILC vs. HER2(-)ILC; 2) HER2+MIX vs. HER2(-)MIX; 3) HER2+ILC vs. HER2+MIX; 4) HER2+ILC vs. HER2+IDC; 5) HER2+MIX vs. HER2+IDC. Results: The number of patients identified for each group was: HER2+ILC (N= 67), HER2(-)ILC (N= 1260), HER2+MIX (N= 92), HER2(-)MIX (N= 932), HER2+IDC (N= 3080). Specifically for both the HER2+ILC and HER2+MIX groups, 24% patients were stage I, 43% stage II and 33% stage III. The median age at diagnosis was 53 years (y) in HER2+ILC, and 49 y in HER2+MIX. The ER/PR were both negative in 16% of HER2+ILC patients, and in 25% of HER2+MIX. While 80% of patients in these two groups received chemotherapy, 36% of HER2+ILC patients received trastuzumab compared to 50% of HER2+MIX. The median follow up was 60 months in the HER2+ILC group and 53 months in the HER2+MIX group. DFS and OS were not statistically different between all groups compared. However, the subgroup of ER/PR negative HER2+MIX patients had a better OS compared to ER/PR/HER2 negative (triple negative) MIX patients (Hazard ratio = 0.4, 0.2 – 0.9, p= 0.026). Conclusions: HER2+ILC and HER2+MIX are rare clinical entities and their survival outcomes may not differ from the more common HER2(-)ILC, HER2(-)MIX and HER2+IDC. ER/PR negative HER2+MIX may have an OS advantage over triple negative MIX tumors.

Adjuvant or neoadjuvant chemotherapy in early stage triple negative breast cancer (TNBC) comparison of outcomes in both BRCA positive and BRCA negative patients.

2017 ◽  
Vol 35 (15_suppl) ◽  
pp. 576-576
Author(s):  
Katherine Clifton ◽  
Angelica Gutierrez Barrera ◽  
Junsheng Ma ◽  
Roland L. Bassett ◽  
Jennifer Keating Litton ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Survival Data ◽  
Early Stage ◽  
Disease Free Survival ◽  
Stage I ◽  
Cancer Center ◽  
Eligibility Criteria ◽  
Genetic Test Results ◽  
Significant Difference ◽  
Brca Negative

576 Background: NSABP Protocol B-18 was a randomized trial which found no statistically significant difference in overall survival (OS) in patients (pts) receiving neoadjuvant (NAC) or adjuvant chemotherapy (AC), however outcome was not analyzed by breast cancer subtypes. Subsequent retrospective studies in TNBC reported conflicting results with an initial study showing a significant OS benefit with AC and later studies showing a trend toward improved survival with NAC. Furthermore, studies have not included a significant number of pts with BRCA mutations. This study aims to analyze outcomes of AC versus NAC in pts with early stage TNBC with and without BRCA germline mutations. Methods: Pts with stage I or II TNBC who had BRCA testing were identified from a prospective cohort study of 4027 pts at MD Anderson Cancer Center. Clinical, demographic, genetic test results, chemotherapy, recurrence, survival data were collected. OS and disease free survival (DFS) were estimated using the Kaplan-Meier method, and log-rank tests were used to compare groups. Results: 305 pts with stage I and II TNBC who met eligibility criteria were included in the analysis. Pts who received both NAC and AC or no chemotherapy were excluded. 181 received AC (59.3%) and 124 received NAC (40.7%). The majority of the pts were less than 50 years old (236, 77.4%) and white (194, 63.8%). 134 were BRCA positive (44.1%) and 170 were BRCA negative (55.9%). The majority of the pts received an anthracycline and taxane regimen (223, 73.1%). There was no significant association between OS or DFS and treatment with NAC versus AC in the overall cohort. Furthermore, there were no significant differences between pt subgroups (NAC BRCA positive, NAC BRCA negative, AC BRCA positive, and AC BRCA negative) with respect to either OS or DFS. Conclusions: NAC versus AC with standard anthracycline and taxane containing regimens results in similar DFS and OS survival amongst pts with stage I and II TNBC regardless of BRCA status. Further studies are needed to evaluate whether similar results are observed with newer agents, such as platinums, PARP inhibitors and other targeted agents.

Outcomes of patients with malignant pleural mesothelioma (MPM) following the approval cisplatin/pemetrexed: Experience of a comprehensive cancer center.

2012 ◽  
Vol 30 (15_suppl) ◽  
pp. e17528-e17528
Author(s):  
Deepa Jagtap ◽  
Harvey Pass ◽  
Frank Baciewicz ◽  
Antoinette J. Wozniak ◽  
Miguel Alvelo-Rivera ◽  
...  
Keyword(s):  
Cox Regression ◽  
Early Stage ◽  
Cox Model ◽  
The United States ◽  
Stage I ◽  
Phase Iii ◽  
Comprehensive Cancer Center ◽  
Cancer Center ◽  
Chemotherapeutic Regimen ◽  
History Of

e17528 Background: Mesothelioma is a rare cancer that is estimated to occur in about 2,500 people in the United States every year. MPM is the most common type of mesothelioma. Until 2003 there was no chemotherapeutic regimen approved for the treatment of MPM. The combination of cisplatin/pemetrexed was approved based on improved survival in a randomized phase III study. We analyzed the data of all MPM patients treated at our center, since the approval of this combination, to evaluate the outcomes of these patients. Methods: This retrospective analysis included all patients with MPM evaluated at Karmanos Cancer Institute in Detroit, Michigan, between 2005 to 2010. We analyzed the demographic data, history of asbestosis exposure, histology, clinical stage of diagnosis, treatment received and survival. A multiple Cox regression model was built on age, sex, histology, surgery or not and stage (I&IIvs.III&IV). Results: Fifty-four MPM patients were evaluated between 2005-2010. The median age of patients was 65 years, 70% were males, 74% had known history of asbestos exposure, 76% had epitheloid histology and 63% had stage III/IV disease at diagnosis. Seventy eight percent of patients received pemetrexed based therapy, 50% underwent pleural surgery (EPP-30%, Pleurectomy- 20%) and 37% received radiation therapy as part of the initial therapy. Twenty-one patients underwent surgery following neo-adjuvant chemotherapy. Thirty-nine percent of patients went on to receive second line therapy. The median overall survival was 18 months (95% CI 14- 22). COX model analysis showed that patients with epitheloid histology had a HR of 0.40, p= 0.0168) and patients who were stage I/II had a HR of 0.42, p = 0.0282. Surgery resulted in a HR of 0.66, but it was not statistically significant (p=0.2637). Age and sex were not significantly associated with survival. Conclusions: The median survival of MPM patients in this series was 18 months. As expected epitheloid histology and early stage at diagnosis were associated with improved survival. Surgery did improve survival but this improvement was not statistically significant.

Prognostic significance of presence of any mucinous component in curatively resected stage II and III colorectal cancer patients who received adjuvant treatments: Data from a single tertiary center.

2013 ◽  
Vol 31 (15_suppl) ◽  
pp. e14660-e14660
Author(s):  
Faysal Dane ◽  
Mehmet Akif Ozturk ◽  
Perran Fulden Yumuk ◽  
Muharrem Kocar ◽  
Mehmet Besiroglu ◽  
...  
Keyword(s):  
Colorectal Cancer ◽  
Survival Data ◽  
Cox Regression ◽  
Early Stage ◽  
Prognostic Significance ◽  
Disease Free Survival ◽  
Rank Test ◽  
Cancer Center ◽  
Mucinous Component ◽  
Tertiary Center

e14660 Background: Mucinous adenocarcinoma colorectal cancer (CRC) is defined as presence of more than 50% mucinous component and its prognostic significance is debatable. We analyzed the prognostic importance of positivity of any mucinous component in early stage adenocarcinoma patients who were operated and received adjuvant treatments in a single tertiary cancer center. Methods: Data from charts of early stage CRC patients curatively treated between January 1998-December 2009 in our clinic was retrospectively analyzed. Cases with any degree of mucine presence in final pathology reports were noted (including mucinous adenocarcinomas). Adjuvant treatments were either 5-FU or oxaliplatin based regimens. All rectal carcinoma patients received postoperative radiotherapy. Survival analyses were made by Kaplan-Meier estimator, and independent factors of survival were tested with Cox regression test. Survival data of subgroups were compared with log-rank test. Results: 532 patients (45% female) were analyzed. Median follow-up was 36 months. Median age at diagnosis was 62 years (24-84). Fifty-four percent of patients had rectal primary (n=292). Presence of any mucinous component was found in 94 patients (17.7%). There was a close relation between mucine presence and T stage (p=0.0001) or tumor grade (p=0.0001). There was no statistical relation between presence of mucine and lymphatic invasion, vascular invasion, or perineural invasion. Five-year disease-free survival for mucine (+) and mucine (-) tumors were, 45.7% and 61.4%, respectively (p=0.031). Five -year overall survival of mucine (+) tumors was worse than mucine (-) tumors (65% vs. 74%, p=0.004). Conclusions: Presence of any mucinous component in early stage CRC appears to be an important bad prognostic feature in our patient group, which was not previously reported in the literature to our knowledge. This “context specific prognostic property” of presence of any mucinous component might serve as a stratification factor for further adjuvant CRC studies.

scholarly journals The impact of lymphadenectomy on prognosis and survival of clinically apparent early-stage malignant ovarian germ cell tumors

2019 ◽  
Vol 50 (3) ◽  
pp. 282-287 ◽  
Author(s):  
Beijiao Qin ◽  
Wenyan Xu ◽  
Yanfang Li
Keyword(s):  
Survival Rate ◽  
Germ Cell ◽  
Early Stage ◽  
Clinical Stage ◽  
Germ Cell Tumors ◽  
Disease Free Survival ◽  
Stage I ◽  
Cancer Center ◽  
Improve Patient Survival ◽  
The Impact

Abstract Objective To determine the impact of lymphadenectomy (LND) on survival of clinically apparent early-stage malignant ovarian germ cell tumors (MOGCTs). Methods We retrospectively analyzed the survival of patients who were diagnosed with the three most common histopathology types of malignant ovarian germ cell tumors (yolk sac tumor, dysgerminoma and immature teratoma) and with clinical stage I and II disease, and treated at Sun Yat-sen University Cancer Center between 1 January 1970 and 30 September 2018. Results There were 227 stage I, 28 stage II and one stage IIIA cases after surgery. One hundred and twenty-six patients underwent lymphadenectomy and 130 did not. Only one lymph node metastasis (0.8%) was found in the lymphadenectomy group. Two hundred and twenty-four out of 256 patients (87.5%) received postoperative chemotherapy. There were five relapses (4.0%) in the lymphadenectomy group and four (3.1%) in the non-lymphadenectomy group. Median follow-up was 68 months (range, 1–388). The 10-year disease-free survival rate in the lymphadenectomy group and non-lymphadenectomy group were 88.2 and 96.4%, respectively (P = 0.412); the 10-year overall survival rate in the two groups were 95.7 and 98.2%; respectively (P = 0.798). The results showed that lymphadenectomy did not improve patient survival. Conclusions Lymphadenectomy may have little impact on survival in patients with clinically apparent early-stage malignant ovarian germ cell tumors and may be omitted in the surgical treatment.

RESULTS OF TREATMENT OF LOCALLY RECURRING SOFT TISSUES SARCOMAS OF EXTREMITIES

2018 ◽  
Vol 64 (3) ◽  
pp. 408-413
Author(s):  
Grigoriy Zinovev ◽  
Georgiy Gafton ◽  
Sergey Novikov ◽  
Ivan Gafton ◽  
Yekaterina Busko ◽  
...  
Keyword(s):  
Radiation Therapy ◽  
Soft Tissues ◽  
Cox Regression ◽  
Disease Free Survival ◽  
Tumor Location ◽  
Long Term Results ◽  
Clinical Feature ◽  
National Medical ◽  
Results Of Treatment ◽  
Kaplan Meier

Background: The most striking clinical feature of soft tissues sarcomas (STS) is their ability to recur. At present disputes about the clinical and morphological factors of STS recurrence such as the degree of malignancy, size, location, depth of tumor location, patient’s age and the presence of previous relapses in the anamnesis do not subside. It also requires clarification of the effect of the volume of tissues removed on the long-term results of treatment of STS as well as indications for the application of various regimes of remote radiation therapy. Materials and methods: Of 1802 registered cases of STS of extremities at the N.N. Petrov National Medical Research Center of Oncology from 2004 to 2016 there were selected data on 213 patients who suffered from at least one relapse of the disease. There was performed an assessment of overall, non-metastatic and disease-free survival using a single-factor (the Kaplan-Meier method) and multivariate analysis (the Cox regression model). Conclusion: The detection of various prognostic factors of locally recurrent STS allows determining the necessary treatment tactics (the vastness and traumatism of surgery and the advisability of radiation therapy).

Prognostic role of aberrant mTOR activation in patients with stage II and III colorectal cancer

2020 ◽  
Vol 14 (12) ◽  
pp. 1127-1137
Author(s):  
Tong-Tong Zhang ◽  
Yi-Qing Zhu ◽  
Hong-Qing Cai ◽  
Jun-Wen Zheng ◽  
Jia-Jie Hao ◽  
...  
Keyword(s):  
Colorectal Cancer ◽  
Cox Regression ◽  
Disease Free Survival ◽  
Stage Ii ◽  
Poor Prognostic Factor ◽  
Cox Regression Analysis ◽  
Kaplan Meier ◽  
Potential Biomarker ◽  
Risk Predictor

Aim: This study aimed to develop an effective risk predictor for patients with stage II and III colorectal cancer (CRC). Materials & methods: The prognostic value of p-mTOR (Ser2448) levels was analyzed using Kaplan–Meier survival analysis and Cox regression analysis. Results: The levels of p-mTOR were increased in CRC specimens and significantly correlated with poor prognosis in patients with stage II and III CRC. Notably, the p-mTOR level was an independent poor prognostic factor for disease-free survival and overall survival in stage II CRC. Conclusion: Aberrant mTOR activation was significantly associated with the risk of recurrence or death in patients with stage II and III CRC, thus this activated proteins that may serve as a potential biomarker for high-risk CRC.

scholarly journals Surgery in Small-Cell Lung Cancer

Cancers ◽  
2021 ◽  
Vol 13 (3) ◽  
pp. 390
Author(s):  
Nicola Martucci ◽  
Alessandro Morabito ◽  
Antonello La Rocca ◽  
Giuseppe De Luca ◽  
Rossella De Cecio ◽  
...  
Keyword(s):  
Lung Cancer ◽  
Small Cell Lung Cancer ◽  
Cell Lung Cancer ◽  
Early Stage ◽  
Small Cell ◽  
Stage I ◽  
Phase Iii ◽  
Small Cell Lung ◽  
Early Stage Disease ◽  
Stage Disease

Small-cell lung cancer (SCLC) is one of the most aggressive tumors, with a rapid growth and early metastases. Approximately 5% of SCLC patients present with early-stage disease (T1,2 N0M0): these patients have a better prognosis, with a 5-year survival up to 50%. Two randomized phase III studies conducted in the 1960s and the 1980s reported negative results with surgery in SCLC patients with early-stage disease and, thereafter, surgery has been largely discouraged. Instead, several subsequent prospective studies have demonstrated the feasibility of a multimodality approach including surgery before or after chemotherapy and followed in most studies by thoracic radiotherapy, with a 5-year survival probability of 36–63% for patients with completely resected stage I SCLC. These results were substantially confirmed by retrospective studies and by large, population-based studies, conducted in the last 40 years, showing the benefit of surgery, particularly lobectomy, in selected patients with early-stage SCLC. On these bases, the International Guidelines recommend a surgical approach in selected stage I SCLC patients, after adequate staging: in these cases, lobectomy with mediastinal lymphadenectomy is considered the standard approach. In all cases, surgery can be offered only as part of a multimodal treatment, which includes chemotherapy with or without radiotherapy and after a proper multidisciplinary evaluation.

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