title: Is neoadjuvant chemotherapy mandatory for limited-disease small-cell lung cancer?
abstract: OBJECTIVE
  The present study attempted to evaluate the role of neoadjuvant chemotherapy combined with surgery in limited-disease small-cell lung cancer (LD-SCLC).
  
  
  METHODS
  A retrospective analysis was performed on 106 LD-SCLC patients who underwent complete resections from February 2000 to February 2012 in Shanghai Pulmonary Hospital. Among these cases, two cycles of neoadjuvant chemotherapies were administered to all pathologically confirmed patients [Group Neoadjuvant (Group N)]. For those without pathology, operations followed by adjuvant chemotherapies were performed [Group Adjuvant (Group A)]. Prognostic features and overall survival (OS) were compared using the log-rank test and calculated using the Kaplan-Meier method.
  
  
  RESULTS
  Group N included 47 cases and Group A included 59 cases. A total of 57 patients were male and 49 were female, with a mean age of 56.1 ± 10.2 years. A total of 41 patients were at pathological stage (p-Stage) IIIa, and 65 patients were at I or II. The overall 5-year survival rate (5-YS) was 28%. The 5-YS for p-Stage I-II (n = 65) was significantly better than that of p-Stage III (n = 41) (35 vs 20%, P = 0.034). For p-Stage IIIa (pN2 positive), the 5-YS of Group N was significantly better than that of Group A (34 vs 12%, P = 0.020). The median overall survival for Group N and Group A in IIIa (pN2 positive) LD-SCLC patients were 46 and 15 months (P = 0.009), respectively. Multivariate analysis for survival showed mediastinal lymph node involvement; surgery and histopathology of SCLC were both significant independent predictors of long-term survival.
  
  
  CONCLUSIONS
  Neoadjuvant chemotherapy combined with surgery provided reasonable options for pIIIa-N2 LD-SCLC patients, which can give them a better chance of survival.
authors.affiliation: Soochow University School of Medicine, Suzhou, Jiangsu, China.
authors.forename: Yong-jie
authors.initials: YJ
authors.lastname: Xu
authors.affiliation: Department of General Thoracic Surgery, Shanghai Pulmonary Hospital, Tongji University School of Medicine, Shanghai, China.
authors.forename: Hui
authors.initials: H
authors.lastname: Zheng
authors.affiliation: Department of General Thoracic Surgery, Shanghai Pulmonary Hospital, Tongji University School of Medicine, Shanghai, China.
authors.forename: Wen
authors.initials: W
authors.lastname: Gao
authors.affiliation: Department of General Thoracic Surgery, Shanghai Pulmonary Hospital, Tongji University School of Medicine, Shanghai, China.
authors.forename: Ge-ning
authors.initials: GN
authors.lastname: Jiang
authors.affiliation: Department of Pathology, Shanghai Pulmonary Hospital, Tongji University School of Medicine, Shanghai, China.
authors.forename: Hui-kang
authors.initials: HK
authors.lastname: Xie
authors.affiliation: Department of General Thoracic Surgery, Shanghai Pulmonary Hospital, Tongji University School of Medicine, Shanghai, China changchenc@hotmail.com ffeik126@126.com.
authors.forename: Chang
authors.initials: C
authors.lastname: Chen
authors.affiliation: Department of General Thoracic Surgery, Shanghai Pulmonary Hospital, Tongji University School of Medicine, Shanghai, China changchenc@hotmail.com ffeik126@126.com.
authors.forename: Ke
authors.initials: K
authors.lastname: Fei
mesh_terms: D000368:Aged; D017024:Chemotherapy, Adjuvant; D016009:Chi-Square Distribution; D002681:China; D005260:Female; D006801:Humans; D053208:Kaplan-Meier Estimate; D008175:Lung Neoplasms / Q000188:drug therapy* / Q000401:mortality / Q000473:pathology / Q000601:surgery; D008207:Lymphatic Metastasis; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D020360:Neoadjuvant Therapy; D009367:Neoplasm Staging; D018579:Patient Selection; D011013:Pneumonectomy; D016016:Proportional Hazards Models; D012189:Retrospective Studies; D012307:Risk Factors; D055752:Small Cell Lung Carcinoma / Q000188:drug therapy* / Q000401:mortality / Q000473:pathology / Q000601:surgery; D013997:Time Factors; D016896:Treatment Outcome
keywords: Neoadjuvant chemotherapy; Small cell lung cancer; Surgery