A retrospective comparative study of surgery followed by chemotherapy vs. non-surgical management in limited-disease small cell lung cancer
A retrospective comparative study of surgery followed by chemotherapy vs. non-surgical management in limited-disease small cell lung cancer
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DOI：
10.1016/j.ejcts.2004.04.012
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发表时间：
2004-07-01
影响因子：
3.4
通讯作者：
Jassem, J
中科院分区：
文献类型：
--
作者：
Badzio, A;Kurowski, K;Jassem, J
目的：手术在局限期小细胞肺癌中的作用仍存在争议。尽管对化疗的反应率非常高，但SCLC患者的预后仍然很差，对于有限的疾病，中位生存期仅为12-14个月。有限期小细胞肺癌化疗后局部复发的高发生率导致重新评估局部治疗在这种肿瘤的多模式管理中的作用。研究方法：我们对1984年至1996年间接受完全切除后化疗（67例）或常规非手术治疗（67例）的134例有限期SCLC患者的生存率进行了回顾性比较分析。在所有接受切除术的患者中，SCLC的诊断仅在术后确定。对照（非手术）组采用“配对病例对照”方法，从176例可能适合手术的有限期患者（即无胸腔积液或其他局部进展，无锁骨上淋巴结受累且体能状态良好）中选择，但未接受切除术治疗。主要预后因素在两组之间平衡良好。总系列包括109名男性和25名女性。T1期20例，T2期114例，N 0期51例，N1期43例，N2期40例。结果：手术组和非手术组的中位生存期分别为22个月和11个月（P < 0.001）。2年和5年生存率分别为43%和27%。在手术组中分别为17%和4%，在非手术组中分别为17%和4%。亚组分析证实，除N2疾病外，所有T和N类别的手术生存期均显著延长。局部复发发生率分别为15%和55%（P < 0.001）。两组的远处复发概率相似（分别为36%和40%）。在整个系列中，最常见的转移部位是脑，其次是肝、淋巴结、骨、肺和皮肤。结论：我们的研究结果表明手术在有限期小细胞肺癌中的可能作用。因此，针对这一问题的随机研究似乎是合理的。(C)2004 Elsevier B. V.保留所有权利。
Objective: The role of surgery in limited SCLC is still a matter of controversy. Even though the response rates to chemotherapy are very high, prognosis of SCLC patients has remained poor with a median survival of only 12-14 months for limited disease. High incidence of local relapses after chemotherapy in limited-stage SCLC led to reassessment of the role of local treatment in the multimodality management of this tumor. Methods: We performed retrospective comparative analysis of survival in a series of 134 limited-stage SCLC patients treated between 1984 and 1996 with either complete resection followed by chemotherapy (67 patients), or with conventional non-surgical management (67 patients). In all patients who underwent resection, the diagnosis of SCLC was established only postoperatively. The control (non-surgical) group was selected using 'pair-matched case-control' methodology, out of 176 limited-stage patients potentially suitable for surgery (i.e. with no pleural effusion or other local advancement, no supraclavicular lymph node involvement and good performance status), but treated without resection. The major prognostic factors were well balanced between these two groups. Total series included 109 males and 25 females. 20 patients with T1 and 114 patients with T2 disease, 51 N0, 43 N1 and 40 N2 disease. Results: Median survival in patients treated with and without surgery was 22 months and 11 months, respectively, (P < 0.001). The two-year and five-year survival probabilities were 43 and 27%. respectively, in the surgical group, and 17 and 4%, respectively, in the non-surgical group. Subset analysis confirmed significantly longer survival with surgery in all T and N categories, except for N2 disease. Local relapse occurred in 15 and 55% of patients treated with and without surgery, respectively, (P < 0.001). Distant relapse probabilities were similar in both groups (36 and 40%, respectively). The most common site of metastases in the entire series was brain, followed by liver, lymph nodes, bone, lung and skin. Conclusions: Our results suggest a possible role of surgery in limited-stage SCLC. Thus, a randomised study addressing this issue seems to be justified. (C) 2004 Elsevier B.V. All rights reserved.