Does thermal ablation plus chemotherapy improve survival in small-cell lung cancer ineligible for surgery?

Background Thermal ablation (TA) is a safe and feasible alternative for the treatment of non-small cell lung cancer. However, data on the clinical efficacy of TA in patients with small-cell lung cancer (SCLC) are scarce. This study aimed to explore the clinical efficacy of TA plus chemotherapy (CHT) in treating SCLC.

Methods We collected data from the SEER database for 51,273 SCLC patients who received CHT from 2000 to 2019. Using propensity score matching (PSM), we balanced covariate differences between two treatment groups: CHT alone and TA plus CHT. Kaplan–Meier survival curves for overall survival (OS) and lung cancer-specific survival (LCSS) were generated. Cox regression analysis was conducted to assess independent prognostic indicators.

Results After PSM, the TA + CHT group exhibited superior OS and LCSS compared to the CHT-only group. Age subgroup analysis revealed that for patients aged ≥70 years, TA + CHT resulted in improved OS and LCSS compared to CHT alone. For patients <70 years, a survival benefit was observed, but the difference was not statistically significant. Tumor size subgroup analysis showed that for patients with tumor sizes of 0–3 cm, TA + CHT led to superior OS and LCSS compared to CHT alone, while no statistically significant differences were observed in other tumor size subgroups. N stage subgroup analysis indicated that for N0 and N1 patients, TA + CHT had better OS and LCSS compared to CHT alone, with no statistically significant differences in the N2 and N3 subgroups. Multivariable analysis indicated that TA + CHT was an independent favorable prognostic indicator for both OS and LCSS.

Conclusions TA + CHT may be a promising treatment option for patients with SCLC, especially those aged ≥70 years with tumor size ≤3 cm, and N0-1 disease.