Long-Term Outcomes and Patterns of Failure After Surgical Resection of Small-Cell Lung Cancer
Long-Term Outcomes and Patterns of Failure After Surgical Resection of Small-Cell Lung Cancer
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DOI：
10.1016/j.cllc.2015.02.004
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发表时间：
2015-09-01
影响因子：
3.6
通讯作者：
Garces, Yolanda I.
中科院分区：
文献类型：
--
作者：
Stish, Bradley J.;Hallemeier, Christopher L.;Garces, Yolanda I.
我们回顾了小细胞肺癌患者接受明确手术切除的结果和失败模式。我们的资料显示，胸内复发是最常见的失败部位，尤其是那些接受有限切除术的患者。仔细选择患者和考虑积极的辅助治疗复发的高风险可能有助于改善outcomes.Background：手术切除作为早期小细胞肺癌（SCLC）的治疗选择的作用是有争议的，很少有数据存在关于这些患者的治疗失败的模式。患者和方法：对1985年1月1日至2012年12月31日在马约诊所（罗切斯特，MN）接受SCLC明确手术治疗的所有患者的病历进行了审查。使用Kaplan-Meier方法记录生存率和复发风险的估计值，并使用考克斯回归分析进行比较分析。结果：共识别出54例患者。中位随访期为5.9年。5年时，总生存率为37%，无复发生存率为44%。胸内复发是最常见的治疗失败，发生在14例患者中，估计3年无胸内复发生存率为64.4%。接受楔形切除术或肺段切除术的患者，而不是接受肺叶切除术或肺切除术的患者，胸内复发的风险增加（风险比，3.5; P = 0.01）。与楔形切除术或肺段切除术相比，肺叶切除术或全肺切除术后5年的总生存率有所提高（分别为48%和15%; P = 0.03）。结论：手术切除小细胞肺癌可获得合理的治疗结果，可考虑用于临床早期疾病的精心选择的患者。胸内复发是治疗失败的最常见部位。对于不能耐受至少肺叶切除术的患者应谨慎，因为他们局部复发的风险很高。(C)2015 Elsevier Inc. All rights reserved.
We reviewed the outcomes and patterns of failure for patients with small-cell lung cancer who had undergone definitive surgical resection. Our data revealed that intrathoracic recurrence was the most common site of failure, especially in those undergoing limited resections. Careful patient selection and consideration of aggressive adjuvant treatment for those at high risk of recurrence might help improve the outcomes.Background: The role of surgical resection as a treatment option for early-stage small-cell lung cancer (SCLC) is controversial, and few data exist regarding the patterns of treatment failure in these patients. Patients and Methods: The medical records of all patients receiving definitive surgical management of SCLC at Mayo Clinic (Rochester, MN) from January 1, 1985 to December 31, 2012 were reviewed. Estimates of survival and recurrence risk were recorded using the Kaplan-Meier method, and comparative analyses were performed with Cox regression analysis. Results: A total of 54 patients were identified. The median follow-up period was 5.9 years. At 5 years, overall survival was 37% and recurrence-free survival 44%. Intrathoracic recurrence, the most frequent treatment failure, occurred in 14 patients, with an estimated intrathoracic recurrence-free survival at 3 years of 64.4%. Patients undergoing wedge resection or segmentectomy, rather than lobectomy or pneumonectomy, had an increased risk of intrathoracic recurrence (hazard ratio, 3.5; P = .01). Overall survival was improved at 5 years after lobectomy or pneumonectomy compared with wedge resection or segmentectomy (48% vs. 15%, respectively; P = .03). Conclusion: Surgical resection of SCLC can achieve reasonable treatment outcomes and can be considered for well-selected patients with clinical early-stage disease. Intrathoracic recurrence is the most common site of treatment failure. Caution should be taken with patients who are unable to tolerate at least lobectomy, because they are at a high risk of local recurrence. (C) 2015 Elsevier Inc. All rights reserved.