Surgical resection of limited disease small cell lung cancer in the new era of platinum chemotherapy: Its time has come
Surgical resection of limited disease small cell lung cancer in the new era of platinum chemotherapy: Its time has come
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DOI：
10.1016/j.jtcvs.2004.08.022
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发表时间：
2005-01-01
影响因子：
6
通讯作者：
Yang, SC
中科院分区：
文献类型：
--
作者：
Brock, MV;Hooker, CM;Yang, SC
目的：虽然切除术不是治疗小细胞肺癌的标准治疗方法，但新的铂类药物和现代分期使手术的作用得到重新评估。方法：我们回顾了1976年至2002年1415例小细胞肺癌患者的临床经验，其中82例（6%）接受了根治性手术。结果：手术时的中位年龄为62岁，混合形态的小细胞肺癌占82例中的14例（17%）。治疗包括11%的病例（9/82）单独手术，22%（18/82）手术联合新辅助治疗，55%（45/82）手术联合辅助治疗。23%（19/82）行预防性头颅照射。整个队列的5年生存率为42%。接受辅助化疗的患者（n = 41）的5年生存率根据患者是否接受铂类或非铂类方案而存在显著差异（68% vs 32.2%，P = 0.04）。在接受辅助化疗的I期患者（n = 24）中，接受铂类和非铂类化疗的患者的5年生存率分别为86%和42%（P <0.02）。如果考虑接受新辅助治疗或辅助治疗的患者（n = 56），铂类化疗的5年生存率显著高于非铂类化疗（62% vs 36%，P = 0.05）。行肺叶切除术的患者（n = 52）的5年生存率也高于行有限切除术的患者（n = 15，50% vs 20%，P = 0.03）。生存结果也因性别而异，女性患者5年生存率优于男性患者（60%比28%，P 0.004）。结论：这些结果支持重新评估手术在小细胞肺癌综合治疗中的作用，目前仅包括放疗和化疗。
Objective: Although resection is not the standard of care in treating small cell lung cancer, new platinum drugs and modern staging have allowed the role of surgery to be reevaluated.Methods: We reviewed our institutional experience of 1415 patients with small cell lung cancer from 1976 to 2002 among whom 82 (6%) underwent surgery with curative intent.Results: Median age at surgery was 62 years, and small cell lung cancer of mixed morphology represented 14 of 82 (17%). Treatment consisted of surgery alone in 11% of cases (9/82), surgery with neoadjuvant therapy in 22% (18/82), and surgery with adjuvant therapy in 55% (45/82). Prophylactic cranial irradiation was given to 23% (19/82). The 5-year survival of the entire cohort was 42%. The 5-year survival of patients receiving adjuvant chemotherapy (n = 41) was significantly different according to whether patients had received platinum or nonplatinum regimens (68% vs 32.2%, P = .04). Among patients with stage I disease who received adjuvant chemotherapy (n = 24), the 5-year survivals for patients receiving platinum and nonplatinum chemotherapy were 86% and 42%, respectively (P < .02). If patients who received either neoadjuvant or adjuvant therapy (n = 56) were considered, the 5-year survival was significantly better for platinum than for nonplatinum chemotherapy (62% vs 36%, P = .05). The 5-year survival was also better for those undergoing lobectomies (n 52) than for those with limited resections (n = 15, 50% vs 20%, P = .03). Survival outcomes also differed by gender, with female patients having a 5-year survival advantage over male patients (60% vs 28%, P. 004).Conclusion: These results support a reevaluation of the role of surgery in the multimodality therapy for small cell lung cancer, which currently includes only radiotherapy and chemotherapy.