Pathological upstaging and treatment strategy of clinical stage I small cell lung cancer following surgery
Small cell lung cancer (SCLC) represents approximately 10–15% of all lung cancers, and its incidence has been steadily decreasing in the past two decades, primarily because of reduction in cigarette smoking, which is the primary cause of this type of tumor (1). SCLC originates from neuroendocrine cell precursors and is characterized by rapid growth, early dissemination to regional lymph nodes, and distant metastasis, and resultant poor prognosis along with initial sensitivity to chemotherapy and radiotherapy (2,3).Current standard therapy for SCLC relies on chemotherapy or chemoradiotherapy, even for patients with “limited” disease. In contrast, the role of primary surgical resection in such patients remains controversial because only a minority of early stage SCLC patients presents without metastasis and are candidates for surgery. Recently, based on favorable surgical results reported in several large cohort studies for limited disease SCLC (4-7), the American College of Chest Physicians (ACCP) indicate surgical has recommended resection only for patients with clinical stage I SCLC (T1–2, N0), followed by chemotherapy (8). Similarly, the National Comprehensive Cancer Network (NCCN) guidelines recommend surgery with adjuvant chemotherapy for stage I disease alone and specify lobectomy as the preferred resection procedure (9).