title: Role of pulmonary resection in the diagnosis and treatment of limited-stage small cell lung cancer: revision of clinical diagnosis based on findings of resected specimen and its influence on survival.
abstract: OBJECTIVE
  Our aims were to evaluate (1) the result of surgical treatment of limited-stage small cell lung cancer (SCLC) by examining long-term survival and prognostic factors, (2) the diagnostic role of surgery by comparing clinical and histopathological diagnoses and staging, and (3) the impact of preoperative diagnostic accuracy on survival.
  
  
  METHODS
  We retrospectively reviewed the clinical profiles of 37 patients treated at our institution between January 1990 and December 2007 for SCLC diagnosed using surgical specimens.
  
  
  RESULTS
  The median follow-up period was 41.2 months, and the 5-year survival rate was 57.5%. Lobectomy or wider resection was performed alone in 33 cases and with mediastinal dissection in 29 cases. Fifteen patients did not receive chemotherapy. SCLC was diagnosed preoperatively or intraoperatively in 75% and non-SCLC in 25%. Clinical stage 1 disease was diagnosed in 29 patients; however, pathological stage 1 was seen in only 20. Patients at pathological stage 1 disease showed better survival than those at stage 2, but a similar result was not obtained in the case of clinical stage of the disease. Tumor size and nodal stage were the only significant factors influencing survival in a multivariate analysis. The adequacy of preoperative clinical diagnosis of tumor extensiveness, nodal involvement, and clinical stage did not significantly influence survival.
  
  
  CONCLUSIONS
  Surgery for limited-stage SCLC was associated with a favorable survival rate and provided important pathological information that can help predict survival. Accuracy of preoperative diagnoses showed no apparent impact on survival for surgically treated SCLC patients.
authors.affiliation: Department of Thoracic Surgery, Osaka City University Graduate School of Medicine, Osaka, Japan. taiwata@med.osaka-cu.ac.jp
authors.forename: Takashi
authors.initials: T
authors.lastname: Iwata
authors.forename: Noritoshi
authors.initials: N
authors.lastname: Nishiyama
authors.forename: Koshi
authors.initials: K
authors.lastname: Nagano
authors.forename: Nobuhiro
authors.initials: N
authors.lastname: Izumi
authors.forename: Shinjiro
authors.initials: S
authors.lastname: Mizuguchi
authors.forename: Takuma
authors.initials: T
authors.lastname: Tsukioka
authors.forename: Ryuhei
authors.initials: R
authors.lastname: Morita
authors.forename: Kyukwang
authors.initials: K
authors.lastname: Chung
authors.forename: Shoji
authors.initials: S
authors.lastname: Hanada
authors.forename: Kiyotoshi
authors.initials: K
authors.lastname: Inoue
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D017024:Chemotherapy, Adjuvant; D005260:Female; D006801:Humans; D007564:Japan; D053208:Kaplan-Meier Estimate; D008175:Lung Neoplasms / Q000401:mortality / Q000473:pathology* / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D020360:Neoadjuvant Therapy; D009367:Neoplasm Staging; D011013:Pneumonectomy / Q000009:adverse effects / Q000401:mortality; D011237:Predictive Value of Tests; D016016:Proportional Hazards Models; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D055752:Small Cell Lung Carcinoma / Q000401:mortality / Q000473:pathology* / Q000601:surgery*; D013997:Time Factors; D016896:Treatment Outcome; D047368:Tumor Burden