The role of surgery in stage I to III small cell lung cancer: A systematic review and meta-analysis

Background
The role of surgery in treating small cell lung cancer (SCLC) remains controversial. This meta-analysis aims to determine whether surgical-based treatment improves survival in comparison to radiotherapy, chemotherapy, and chemoradiotherapy for stage I to III SCLC.
Methods
PubMed, PubMed Central, EMBASE, Web of Science, and Cochrane Library were searched for relevant articles. The main outcome were overall survival (OS), reported as hazard ratios (HRs), and 95% confidence intervals (CIs).
Results
Two randomized control trials (RCTs) and 13 retrospective studies that included a total of 41,483 patients were eligible. Surgical resection significantly improved OS when compared to non-surgical treatment in retrospective studies (HR = 0.56, 95% CI: 0.49–0.64, P < 0.001), but not in the 2 “older” RCTs (HR = 0.77, 95% CI: 0.32–1.84, P = 0.55). In the subgroup analysis for retrospective studies, surgical resection was associated with superior OS in stage I (HR = 0.56, 95% CI: 0.49–0.64, P < 0.001), stage II (HR = 0.75, 95% CI: 0.57–0.99, P = 0.04), and stage III diseases (HR = 0.70, 95% CI: 0.56–0.88, P = 0.002). Sublobar resection resulted in worse OS than a lobectomy (HR = 0.64, 95% CI: 0.56–0.74, P < 0.001) for patients undergoing surgical resection.
Conclusions
Surgery-based multi-modality treatment appears to be associated with a favorable survival advantage in stage I and selected stage II to III SCLC. Lobectomy is likely to provide superior OS when compared to sublobar resection. Further prospective RCTs are needed to confirm these findings.