title: Clinical outcomes of surgically resected combined small cell lung cancer: a two-institutional experience.
abstract: BACKGROUND
  The combined small cell lung cancer (c-SCLC) was rare and its clinicopathological characteristics had not been thoroughly described. The aim of this study was to determine prognostic factors and survival in c-SCLC patients.
  
  
  METHODS
  Clinical records of patients with c-SCLC who underwent surgery between January 2009 and December 2013 in two institutions were retrospectively reviewed.
  
  
  RESULTS
  Ninety-seven patients were identified. The most common pathology was combined SCLC and large cell neuroendocrine carcinoma (LCNEC, N=46), followed by combined SCLC and squamous cell carcinoma (SCC) (N=32), combined SCLC and adenocarcinoma (AC) (N=12), and combined SCLC and adenosquamous carcinoma (ASC) (N=7). The overall survival (OS) rates of the entire cohort were 42.4% and 35.2% at 3 and 5 years, respectively. Multivariate analysis identified sex [femalevs.male, hazards ratio (HR) =0.38; 95% confidence interval (CI): 0.19-0.79; P=0.010], age (<53vs.>53 years, HR =0.28; 95% CI: 0.09-0.81; P=0.019), performance status (<2vs.>2, HR =0.08; 95% CI: 0.02-0.32; P<0.001), combined non-small cell lung cancer (NSCLC) components (LCNECvs.non-LCNEC, HR =3.00; 95% CI: 1.03-8.76; P=0.045), adjuvant therapy (yesvs.no, HR =0.33; 95% CI: 0.17-0.67; P=0.002) as significantly prognostic factors of OS in patients with complete resection and lymphadenectomy.
  
  
  CONCLUSIONS
  The mixed NSCLC components within c-SCLCs had a significant influence on the survival. Compared with surgery alone, adjuvant therapy was associated with significantly improved survival in patients with complete resection and lymphadenectomy.
authors.affiliation: Department of Thoracic Surgery, The Affiliated Luoyang Central Hospital of Zhengzhou University, Luoyang 471000, China.
authors.forename: Chao
authors.initials: C
authors.lastname: Zhang
authors.affiliation: Department of Thoracic Surgery, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai 200030, China;; Division of General Thoracic Surgery, Inselspital University Hospital Bern, Bern, Switzerland;; Department of Clinical Research, University of Bern, Bern, Switzerland;; Graduate School for Cellular and Biomedical Sciences, University of Bern, Bern 3010, Switzerland.
authors.forename: Haitang
authors.initials: H
authors.lastname: Yang
authors.affiliation: Department of Thoracic Surgery, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai 200030, China.
authors.forename: Heng
authors.initials: H
authors.lastname: Zhao
authors.affiliation: Department of Thoracic Surgery, The Affiliated Luoyang Central Hospital of Zhengzhou University, Luoyang 471000, China.
authors.forename: Baoping
authors.initials: B
authors.lastname: Lang
authors.affiliation: Department of Thoracic Surgery, The Affiliated Luoyang Central Hospital of Zhengzhou University, Luoyang 471000, China.
authors.forename: Xiangdong
authors.initials: X
authors.lastname: Yu
authors.affiliation: Department of Thoracic Surgery, The Affiliated Luoyang Central Hospital of Zhengzhou University, Luoyang 471000, China.
authors.forename: Peng
authors.initials: P
authors.lastname: Xiao
authors.affiliation: Department of Thoracic Surgery, The Affiliated Luoyang Central Hospital of Zhengzhou University, Luoyang 471000, China.
authors.forename: Xiao
authors.initials: X
authors.lastname: Zhang
keywords: Combined small cell lung cancer (c-SCLC); surgery; survival