title: Surgical resection should be considered for stage I and II small cell carcinoma of the lung.
abstract: BACKGROUND
  Small cell lung carcinoma (SCLC) is rarely treated with resection, either alone or combined with other modalities. This study evaluated the role of surgical resection in the treatment of stage I and II SCLC.
  
  
  METHODS
  We queried the Surveillance, Epidemiology, and End Results (SEER) database for patients from 1988 to 2007 with SCLC. Survival was determined by Kaplan-Meier analysis and compared using the log-rank test. A Cox proportional hazard model identified relevant survival variables.
  
  
  RESULTS
  We identified 3,566 patients with stage I or II SCLC. Lung resection was performed in 895 (25.1%), wedge resection in 251 (28.0%), lobectomy or pneumonectomy in 637 (71.2%), and lung resection not otherwise specified in 7 (0.78%). Median survival was 34.0 months (95% confidence interval [CI], 29.0 to 39.0 months) vs 16.0 months (95% CI, 15.3 to 16.7; p<0.001) in nonsurgical patients. Median survival after lobectomy or pneumonectomy was 39.0 months (95% CI, 30.7 to 40.3) and significantly longer than after wedge resection (28.0 months; 95% CI, 23.2 to 32.8; p=0.001). However, survival after wedge resection was still significantly longer than survival in nonsurgical patients (p<0.001). Sex (p=0.013), age, stage at diagnosis, radiotherapy, and operation (all p<0.001) significantly affected survival. In the surgical patients, sex (p=0.001), age (p<0.001), final stage (p<0.001), and type of resection (p=0.01) were important determinants of survival.
  
  
  CONCLUSIONS
  Surgical resection as a component of treatment for stage I or II SCLC is associated with significantly improved survival and should be considered in the management of early-stage SCLC.
authors.affiliation: Department of Cardiothoracic Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania 15213, USA. wekslerb@upmc.edu
authors.forename: Benny
authors.initials: B
authors.lastname: Weksler
authors.forename: Katie S
authors.initials: KS
authors.lastname: Nason
authors.forename: Manisha
authors.initials: M
authors.lastname: Shende
authors.forename: Rodney J
authors.initials: RJ
authors.lastname: Landreneau
authors.forename: Arjun
authors.initials: A
authors.lastname: Pennathur
mesh_terms: D000368:Aged; D001707:Biopsy, Needle; D016001:Confidence Intervals; D016208:Databases, Factual; D018572:Disease-Free Survival; D004502:Education, Medical, Continuing; D005260:Female; D006801:Humans; D007150:Immunohistochemistry; D053208:Kaplan-Meier Estimate; D008175:Lung Neoplasms / Q000401:mortality / Q000473:pathology* / Q000532:radiotherapy / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D011013:Pneumonectomy / Q000379:methods* / Q000401:mortality / Q000706:statistics & numerical data; D011379:Prognosis; D016016:Proportional Hazards Models; D018714:Radiotherapy, Adjuvant; D012189:Retrospective Studies; D018570:Risk Assessment; D018426:SEER Program; D055752:Small Cell Lung Carcinoma / Q000401:mortality / Q000473:pathology* / Q000532:radiotherapy / Q000601:surgery*; D018709:Statistics, Nonparametric; D016019:Survival Analysis; D016896:Treatment Outcome