INFLUENCE OF SURGICAL RESECTION PRIOR TO CHEMOTHERAPY ON THE LONG-TERM RESULTS IN SMALL-CELL LUNG-CANCER - A STUDY OF 150 OPERABLE PATIENTS
INFLUENCE OF SURGICAL RESECTION PRIOR TO CHEMOTHERAPY ON THE LONG-TERM RESULTS IN SMALL-CELL LUNG-CANCER - A STUDY OF 150 OPERABLE PATIENTS
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DOI：
10.1016/0277-5379(86)90048-9
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发表时间：
1986-05-01
期刊：
影响因子：
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通讯作者：
DOMBERNOWSKY, P
中科院分区：
文献类型：
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作者：
OSTERLIND, K;HANSEN, M;DOMBERNOWSKY, P
在1973年至1981年期间，对874例接受强化联合化疗加或不加放射治疗的可手术小细胞肺癌（SCC）患者进行了连续系列研究，评价了化疗前手术切除对治疗长期结果的影响。根据支气管纵隔镜检查、胸部X线片、骨髓检查、腹腔镜肝活检和肺功能检查评估疾病分期和可手术性。化疗18个月后进行的再分期采用相同的分期程序。该系列包括440例广泛性疾病患者和437例局限性疾病患者，其中150例被认为是可手术的。54例可手术患者没有接受开胸手术，因为SCC的治疗政策不包括在他们转诊的医院进行手术。这些患者作为参考，与手术患者的数据进行比较。手术切除52例，不能切除44例。36例切除被认为是组织学上完整的，而16例患者被证明有显微镜（9例）或肉眼（7例）残留肿瘤。874例患者中30个月无瘤生存者的数量和百分比如下：完全切除12/36例（33%），切除后残留肿瘤2/16例（33%），（12.5%）;可手术但非手术，7/54（13%）;不可切除，3/44（6.8%）;局限性病变的不可手术患者，15/284（5.3%）;广泛性病变的不可手术患者，11/440（2.5%）。在切除的残留肿瘤患者和可手术的非手术患者中观察到的长期生存率之间的相似性表明，切除本身对SCC的长期结果没有显著影响。因此，完全切除患者的相对高的长期生存率可能主要是化疗开始时疾病早期的结果。
The effect of surgical resection, prior to chemotherapy, on the long-term results obtained in treatment of operable patients with small cell lung cancer (SCC) was evaluated in a consecutive series of 874 patients treated with intensive combination chemotherapy with or without irradiation between 1973 and 1981. Evaluation of disease stage and operability was based on broncho-mediastinoscopy, chest X-ray, bone marrow examination, peritoneoscopy with liver biopsy and lung function tests. The same staging procedures were applied for restaging performed after 18 months of chemotherapy. The series comprised 440 patients with extensive disease and 437 with limited disease of whom 150 were regarded operable. Fifty-four operable patients received no thoracotomy because the treatment policy of SCC did not include surgery at the hospitals from which they were referred. These patients served as a reference with which data on operated patients were compared. Resections were performed in 52 patients while 44 were regarded to be irresectable at the thoracotomy. Thirty-six resections were regarded histologically complete while 16 patients proved to have microscopic (9 pts) or macroscopic (7 pts) residual tumor. The number and per cent of 30 months disease-free survivors in the various categories of the 874 patients were as follows: Completely resected, 12/36 patients (33%); Resected with residual tumor, 2/16 (12.5%); Operable but non-operated, 7/54 (13%); Irresectable, 3/44 (6.8%); Non-operable patients with limited disease, 15/284 (5.3%) and with extensive disease, 11/440 (2.5%). The similarity between rates of long-term survival observed in resected patients with residual tumor and operable, non-operated patients suggests that resection, per se, has no significant influence on long-term results in SCC. The relatively high rate of long-term survival in completely resected patients may therefore primarily be a result of early stage disease at the initiation of chemotherapy.