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. 2019 May;14(5):914-923.
doi: 10.1016/j.jtho.2019.01.019. Epub 2019 Feb 5.

Surgical Resection of SCLC: Prognostic Factors and the Tumor Microenvironment

Xiaoliang Zhao  1 , Bhaskar Kallakury  2 , Joeffrey J Chahine  2 , Dan Hartmann  2 , YuWen Zhang  2 , Yulong Chen  3 , Hua Zhang  3 , Bin Zhang  3 , Changli Wang  3 , Giuseppe Giaccone  4
Affiliations

Surgical Resection of SCLC: Prognostic Factors and the Tumor Microenvironment

Xiaoliang Zhao et al. J Thorac Oncol. 2019 May.

Abstract

Introduction: Surgery in SCLC is limited to very early stages, but several reports suggest a potential broader role. Little is known of the influence of microenvironment on the biology of SCLC.

Methods: We assessed the clinical prognostic factors in a large series of resected SCLC patients. The prognostic value of programmed cell death ligand 1 (PD-L1) expression in tumor cells and tumor infiltrating lymphocytes (TILs) and the percentage of CD3-, CD20-, CD45- and CD68-positive cells, were also investigated.

Results: Two hundred five SCLC cases were resected between 2005 and 2015 and the median follow-up was 29 months (range: 2 to 135 months). Median survival of all patients was 69 months, and 5-year survival rates were 63.8%, 65.5%, 34.9%, and 0% for pathologic stages I, II, III, and IV, respectively. By multivariate analysis complete resection, cigarette index, lymph node metastatic rate, percentage of CD3-positive cells, PD-L1 expression in tumor cells, and TILs were independent prognostic factors. High PD-L1 expression was present in 3.2% and 33.5% of all tumor samples in tumor cells and TILs, respectively. High PD-L1 expression in tumor cells or TILs correlated with shorter survival, whereas high expression of CD3, CD20, and CD45 correlated with better survival.

Conclusions: Resected stage II SCLC patients have similar survival as stage I, suggesting that surgery could be extended to patients with hilar lymph node involvement. Survival was better in tumors with a higher percentage of T cells and B cells, whereas PD-L1 expression in tumor cells and TILs correlated with worse survival, which suggests a potential role of immunotherapy in resected SCLC.

Keywords: Prognosis; Programmed death ligand 1; Ratio of metastatic lymph nodes; SCLC; Surgery.

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Conflict of interest statement

All authors report no conflict of interest

Figures

Figure 1.
Figure 1.
Overall survival curves for (A) all 205 resected SCLC patients; (B) by pathological stage (blue, stage I; green, stage II; brown, stage III; purple, stage IV).
Figure 2.
Figure 2.
Overall survival curves by: (A) cigarette index; (B) surgery type; (C) LNR; (D) ELN; (E) complete resection/R0 resection; (F) histology; (G) age; and (H) adjuvant chemotherapy. All p<0.05.
Figure 3.
Figure 3.
Overall survival curves by (A) PD-L1 expression in tumor cells (using 50% as the cut-off value); (B) PD-L1 expression in TILs; (C) CD3 positive percentage; (D) CD20 positive percentage; (E) CD45 positive percentage; (F) CD68 positive percentage. All p<0.05 except CD68 (p=0.229).
See this image and copyright information in PMC

Comment in

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