J Thorac Cardiovasc Surg 2011;142:544-546
© 2011 The American Association for Thoracic Surgery
Discussion
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Dr Jessica Donington
(New York, NY). Thoracic surgery has been discounted for the treatment of SCLC since the 1970s and 1980s because of some randomized trials that lumped all of the limited disease together, probably inappropriately. I think the nice work Eric Vallieres did as part of the International Association for the Study of Lung Cancer Lung Cancer Staging Project showed us that for patients with SCLC without metastatic disease, both the T stage and the N stage carry significant prognostic and therapeutic implications. I congratulate you on this excellent work. In looking at that, do we have to look at this as a review of SEER data? I have actually never performed a SEER review, so maybe you can educate me as to some of the things we can and can't take out of this. When we look at the way the patients were staged in this series, I'm assuming that we have both clinical and pathologic stages that we are comparing between the radiation and the surgery groups. Correct?
Dr DeCamp. SEER reports the use of surgery and reports down to the histology of lymph nodes that are sampled, so in the surgery group, obviously there is more precise staging than in the patients with no resection, so they may have only a biopsy, as you saw in Tables 1 and 2.
Dr Donington. So it would be comparing apples and oranges in terms of survival. I guess the same may also be true in that we don't really know about intention to treat and the use of sublobar versus lobectomy or greater in treatment. I'm assuming the sublobars in this series were probably performed in patients who could not tolerate a lobectomy, or we just don't have any information?
Dr DeCamp. We have no knowledge of . . . [Full Text of this Article]
Copyright © 2011 by The American Association for Thoracic Surgery.
