Trends in Surgical Management of Early-stage Small Cell Lung Cancer

Background Small cell lung cancer (SCLC) represents about 15% of all lung cancer diagnoses and carries a poor prognosis. The goal herein is to elucidate trends, and factors underlying trends, in surgical management of early-stage small cell lung cancer. Methods We identified patients > 18 years of age diagnosed with American Joint Committee on Cancer clinical stage IA-IIA small cell lung cancer within the National Cancer Database (NCDB). Patients included were diagnosed from 2004-2023. The historical era was 2004-2018; the modern era was defined as 2019-2023. Chi-square tests, multivariable logistic regression, Kaplan-Meier plots, log-rank tests, and Cox proportional hazards model were used as appropriate. Results 26,374 (6.6%) patients presented at stages IA-IIA. Of these, 7,180 (27.2%) underwent surgery. The rate of surgery significantly increased, with only 13.7% of patients receiving surgery in 2004 versus 34.7% in 2023 (p<0.001). Of variables underlying receipt of surgery, clinical stage had the largest effect size (IB (0.34 [0.32-0.37]) and IIA (0.20 [0.18-0.22]). In 2004, 43.1% of patients presented at stage IA compared to 88.6% in 2023. Patients receiving surgery demonstrated improved survival in an adjusted model (0.63 [0.58-0.69], p<0.001) and after propensity matched analysis (p<0.001). Finally, sub-lobar resection was associated with worse survival (1.33 [1.23-1.45], p<0.001). Conclusion The rate of surgical management has significantly increased over time. This likely reflects earlier diagnosis of SCLC, which facilitates appropriate surgical management. These data also demonstrate surgical resection is associated with improved survival, as is lobectomy versus a sub-lobar resection. Micro abstract Herein, we aim to elucidate trends in the surgical management of small cell lung cancer between 2004-2023. The rate of surgery significantly increased, with 13.7% of patients receiving surgery in 2004 versus 34.7% in 2023 (p<0.001) and surgery demonstrated improved survival after propensity matched analysis (p<0.001). Clinical stage was the dominant variable underlying this trend, with the largest effect sizes (IB (0.34 [0.32-0.37]) and IIA (0.20 [0.18-0.22] versus IA). In 2004, 43.1% of patients presented at stage IA versus 88.6% in 2023. These findings demonstrte association between surgery and improved survival, likely facilitated by improved early detection of tumors