Abstract
BACKGROUND: Small cell lung cancer (SCLC) is an aggressive malignancy with limited treatment options. While surgery is increasingly considered for early-stage disease, its prognostic implications remain poorly characterized, and validated predictive tools are lacking. METHODS: This retrospective study analyzed 7718 patients from the SEER database and 237 patients from Tianjin Medical University General Hospital. Clinical variables including surgical approach, TNM stage, and adjuvant therapies were evaluated. Prognostic factors were identified through Cox regression, and a nomogram was developed from SEER data with external validation in the independent cohort. RESULTS: Surgical resection was associated with improved survival in stage I-IIIA patients but showed no benefit in stage IIIB-IV disease. Multivariate analysis identified TNM stage, lobectomy (versus sublobar resection), and postoperative chemotherapy as independent prognostic factors. The nomogram demonstrated strong predictive performance, with 1-, 3-, and 5-year AUC values of 0.871/0.727/0.725 in the development cohort and 0.775/0.744/0.723 in the validation cohort. CONCLUSIONS: Our findings support surgical consideration for early-stage SCLC and provide a validated prognostic tool for clinical decision-making. The nomogram incorporating TNM stage, surgical extent, and adjuvant therapy effectively predicts survival outcomes, offering practical guidance for treatment planning.