The Role of Resection for Stage II Small Cell Lung Cancer

Background We sought to determine whether surgery provides a survival benefit for patients with stage II small cell lung cancer (SCLC). Methods We compared patients with stage II SCLC who underwent surgical resection with those who did not using the National Cancer Database from 2004-2020. Groups were propensity-matched and overall survival difference was compared with Kaplan-Meier analysis. Results We identified 6797 patients with stage II SCLC who received treatment. Only 10% underwent surgery. Ninety percent of patients underwent nonsurgical treatment, with the most common treatment being chemotherapy combined with radiation (n = 4610). After propensity matching, the surgical cohort had higher overall survival: 79.1% vs 70.6% at 1 year and 33.2% vs 20.4% at 5 years ( P < .001). Conclusions In a propensity-matched analysis of patients in the National Cancer Database with stage II SCLC, we found sustained survival benefit for patients whose treatment included surgery. This survival benefit was present for both N0 and N1 disease, but most pronounced for N0 patients.