中国胸心血管外科临床杂志

中国胸心血管外科临床杂志

分析新辅助化疗对于局限期小细胞肺癌治疗的价值

查看全文

目的 研究新辅助化疗在局限期小细胞肺癌(small cell lung cancer,SCLC)患者中治疗的效果。 方法 回顾性分析 2007 年 5 月至 2016 年 8 月中日友好医院胸外科行手术治疗的局限期 SCLC 患者的临床资料,比较直接手术组与新辅助化疗组的生存差异。 结果 共 55 例局限期 SCLC 患者,中位生存期 27 个月,1 年、3 年、5 年总生存率分别为 89.1%、45.0%、33.8%。单因素分析:治疗方式(新辅助化疗和直接手术)和临床 N 分期对预后具有明显统计学意义(P<0.05)。Cox 比例风险回归模型进行多因素生存分析:临床 N 分期是预后的独立影响因素。 结论 临床Ⅰ和Ⅱ期患者推荐手术治疗,手术后继续后续的多学科治疗;临床Ⅲ期推荐先行新辅助治疗,根据对化疗药物反应决定下一步治疗方案;淋巴结转移对生存期有显著的影响;精确的临床分期对治疗至关重要。

Objective To investigate the significance of neoadjuvant chemotherapy in the treatment of limited stage small cell lung cancer. Methods We enrolled 55 LD-SCLC patients who underwent surgery in Department of Thoracic Surgery, China-Japan Friendship Hospita from May 2007 to August 2016. All patients underwent clinical staging before treatment. The comparison of long term survival rates was made between preoperative neoadjuvant chemotherapy group and direct surgery group. Results Among 55 patients, Median survival time was 27 months, The 1-, 3-, 5-year survival rate were 89.1%, 45.0%, 33.8% respectively. Treatment methods and clinical N stage were significantly different in prognosis (P<0. 05). The results of Cox proportional hazards regression model showed that clinical N stage was prognostic factor of LD-SCLC patients (P<0. 05). Conclision Patients with clinical satge I and II SCLC were better to receive direct surgery. For patients with clinical stage III, it was recommended to reach PR/CR with neoadjuvant chemotherapy before surgery. The status of lymph node metastasis was closely related to survival, thus indentifying the accurate clinical stage is crucial before treatment.

关键词: 小细胞肺癌; 手术; 新辅助化疗

Key words: Small cell lung cancer; surgery; neoadjuvant chemotherapy

登录后 ,请手动点击刷新查看全文内容。 没有账号,
登录后 ,请手动点击刷新查看图表内容。 没有账号,
1. Chen W, Zheng R, Baade PD, et al. Cancer statistics in China, 2015. CA Cancer J Clin, 2016, 66(2): 115-132.
2. Siegel RL, Miller KD, Jemal A. Cancer Statistics, 2017. CA Cancer J Clin, 2017, 67(1): 7-30.
3. Pesch B, Kendzia B, Gustavsson P, et al. Cigarette smoking and lung cancer--relative risk estimates for the major histological types from a pooled analysis of case-control studies. Int J Cancer, 2012, 131(5): 1210-1219.
4. Schreiber D, Rineer J, Weedon J, et al. Survival outcomes with the use of surgery in limited-stage small cell lung cancer: should its role be re-evaluated. Cancer, 2010, 116(5): 1350-1357.
5. Combs SE, Hancock JG, Boffa DJ, et al. Bolstering the case for lobectomy in stages Ⅰ, Ⅱ, and ⅢA small-cell lung cancer using the National Cancer Data Base. J Thorac Oncol, 2015, 10(2): 316-323.
6. Fujimori K, Yokoyama A, Kurita Y, et al. A pilot phase 2 study of surgical treatment after induction chemotherapy for resectable stage Ⅰ to ⅢA small cell lung cancer. Chest, 1997, 111(4): 1089-1093.
7. Hara N, Ohta M, Ichinose Y, et al. Influence of surgical resection before and after chemotherapy on survival in small cell lung cancer. J Surg Oncol, 1991, 47(1): 53-61.
8. Wada H, Yokomise H, Tanaka F, et al. Surgical treatment of small cell carcinoma of the lung: advantage of preoperative chemotherapy. Lung Cancer, 1995, 13(1): 45-56.
9. Veronesi G, Scanagatta P, Leo F, et al. Adjuvant surgery after carboplatin and VP16 in resectable small cell lung cancer. J Thorac Oncol, 2007, 2(2): 131-134.
10. Ohkubo T, Ito K, Sugiura H, et al. Surgical analysis for small cell lung cancer of the lung. Kyobu Geka, 1999, 52(13): 1061-1066.
11. Lucchi M, Mussi A, Chella A, et al. Surgery in the management of small cell lung cancer. Eur J Cardiothorac Surg, 1997, 12(5): 689-693.
12. Jin F, Qu B, Fu Z, et al. Prognostic Value of metabolic parameters of metastatic lymph nodes on (18)F-FDG PET/CT in patients with limited-stage small-cell lung cancer with lymph node involvement. Clin Lung Cancer, 2018, 19: e101-e108.
13. Nakamura H, Kato Y, Kato H. Outcome of surgery for small cell lung cancer--response to induction chemotherapy predicts survival. Thorac Cardiovasc Surg, 2004, 52(4): 206-210.
14. Friess GG, McCracken JD, Troxell ML, et al. Effect of initial resection of small-cell carcinoma of the lung: a review of Southwest Oncology Group Study 7628. J Clin Oncol, 1985, 3(7): 964-968.
15. 段勇, 白连启, 龚昌帆, 等. 术前化疗对小细胞肺癌远期生存的影响. 中华医学杂志, 2009, 89(31): 2199-2201.