Increased rates of surgical resection of early-stage small cell lung cancer in a single-institution cohort

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Background: Increasing chest imaging utilization, including for screening, identifies more non-small cell lung cancer (NSCLC) at earlier stages. We suspected that a parallel increase in early detection and resection of small cell lung cancer (SCLC) was also occurring. We therefore reviewed our institutional experience to explore trends in surgically resected SCLC frequency and outcomes. Methods: A single-institution, retrospective review was performed of all SCLC cases resected between 2000–2022. We evaluated demographics, oncologic characteristics, overall survival (OS), and disease-free survival (DFS). Results: Among 30 patients with resected SCLC, the majority underwent lobectomy (73%) and only 37% were known to have SCLC preoperatively. The frequency of resections increased over time with almost half (47%) occurring in the last four study years (2019–2022). This increase in SCLC resections coincided with increasing lung cancer screening (LCS) volume, with no change in thoracic surgical case volume. The 2019–2022 cohort was predominantly clinical stage I (86%) compared to 56% pre-2019 (I vs. II–IV, P=0.08), and also trended toward more screen-detected (43% vs. 13%, P=0.08) patients. Subgroup analysis showed encouraging OS outcomes following surgical resection for clinical and pathological stage I patients. There was a trend toward better OS among screen-detected patients (73% vs. 34%, log-rank P=0.07) that was significant in DFS (75% vs. 26%, P=0.02). Conclusions: The number of surgically resected SCLC patients at our institution has increased in recent years, as has the proportion of screen-detected and clinical stage I cases, alongside rising LCS volume. This may be an early signal of a broader trend toward increasing diagnosis of limited stage SCLC eligible for resection.

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