METASTATIC PATTERNS IN SMALL-CELL LUNG-CANCER - CORRELATION OF AUTOPSY FINDINGS WITH CLINICAL-PARAMETERS IN 537 PATIENTS
METASTATIC PATTERNS IN SMALL-CELL LUNG-CANCER - CORRELATION OF AUTOPSY FINDINGS WITH CLINICAL-PARAMETERS IN 537 PATIENTS
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DOI：
10.1200/jco.1987.5.2.246
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发表时间：
1987-02-01
影响因子：
45.3
通讯作者：
HANSEN, HH
中科院分区：
文献类型：
--
作者：
ELLIOTT, JA;OSTERLIND, K;HANSEN, HH
尸检材料从537例患者包括在各种协议的强化联合化疗或放化疗的管理小细胞间变性肺癌（SCLC）进行了审查。残留或复发疾病的模式与治疗前的临床参数进行了分析。与广泛分期的患者相比，早期局限期患者的残留原发肿瘤（P <0.05）、区域淋巴结转移（P <0.01）、肝转移（P <0.01）、骨转移（P <0.05）和肾转移（P <0.05）的发生率均显著降低。部分缓解者（PR）和无缓解者（NR）之间胸内残留肿瘤和转移模式的频率无显著差异。与局限期PR患者相比，局限期PR患者尸检时胸内肿瘤的发生率较低（P <0.001）。然而，对于广泛期患者，残留疾病的模式基本上是独立的肿瘤反应。既往手术仅在接受根治性切除术的患者中与转移负担减轻相关。与单纯化疗组相比，原发灶和纵隔放疗组尸检残留肿瘤分布无明显改变。有或无预防性腹部放疗的转移模式相似，而预防性头颅放疗（PCl）并不能阻止对治疗的全身反应为部分或不存在的患者发生脑转移。然而，不排除PCI在完全应答者（CR）中的有益作用。
Postmortem material from 537 patients included in various protocols of intensive combination chemotherapy or chemoradiotherapy for the management of small-cell anaplastic carcinoma of the lung (SCLC) has been reviewed. Patterns of residual or recurrent disease were analyzed in relation to the pretreatment clinical parameters. Residual primary tumor (P < .05), regional lymph node involvement (P < .01), hepatic (P < .01), bone (P < .05), and renal metastases (P < .05) were all significantly less frequent among patients with initially limited-stage disease compared with extensively staged patients. The frequency of residual intrathoracic tumor and metastatic pattern did not significantly differ between partial responders (PRs) and nonresponders (NRs). Patients with limited disease achieving a complete remission had a lower frequency of intrathoracic tumor (P < .001) at autopsy compared with limited-stage PRs. However, for extensive-stage patients the pattern of residual disease was essentially independent of tumor response. Prior surgery was associated with a reduced burden of metastases only in those who underwent a radical resection. The addition of radiotherapy to the primary tumor and mediastinum failed to modify the autopsy distribution of residual tumor compared with that in patients treated with chemotherapy alone. Metastatic patterns were similar with or without prophylactic abdominal radiotherapy, while prophylactic cranial irradiation (PCl) did not prevent the development of cerebral metastases in patients whose systemic response to treatment was either partial or nonexistent. However, a beneficial effet of PCl in complete responders (CRs) was not excluded.