Surgery-based treatment and prognostic factors in patients with limited-stage small cell lung cancer: a retrospective cohort study

Introduction Small cell lung cancer (SCLC) is an aggressive malignancy with poor prognosis, and the role of surgery in limited-stage disease remains controversial. This study evaluated the impact of surgery-based treatment for limited-stage SCLC (LS-SCLC) and identified prognostic factors. Methods Clinical data of 103 highly selected patients who underwent complete R0 resection and perioperative adjuvant therapy at the Fourth Hospital of Hebei Medical University from 2014 to 2019 were retrospectively analyzed. Disease-free survival (DFS) and overall survival (OS) were assessed by Kaplan-Meier analysis, and independent prognostic factors were determined using multivariable Cox regression. Results The cohort included 60 males and 43 females, aged 22–76 years, with a median follow-up of 64 months (IQR: 25–83 months). The median OS was 81 months, and the 5-year OS rate was 58.3%; the median DFS was 50 months, and the 5-year DFS rate was 50.5%. Patients with stage I-IIA disease had significantly better survival than those with stage IIB-IIIB (5-year OS: 69.2% vs. 47.1%, P = 0.017; 5-year DFS: 67.3% vs. 33.3%, P 0.001). Multivariable analysis identified advanced pathological Tumor-Node-Metastasis (pTNM) stage (HR = 1.848, 95% CI: 1.156-2.956, P = 0.010) as an independent adverse prognostic factor, whereas adjuvant chemotherapy plus thoracic radiotherapy was associated with improved survival. Furthermore, postoperative brain metastasis was a post-treatment progression event associated with markedly poor outcomes (5-year OS: 21.9% vs. 74.6%, P 0.001). Conclusions In this highly selected cohort, radical surgery followed by adjuvant chemotherapy and thoracic radiotherapy was associated with improved survival in LS-SCLC, particularly in stage IIB or higher disease. Given the absence of a non-surgical control group, these findings are hypothesis-generating and warrant prospective validation. Postoperative brain metastasis, as a post-treatment progression event, was associated with markedly poor outcomes.