手术治疗小细胞肺癌价值的分析

Value of surgery in treating small cell lung cancer

目的:本研究旨在探讨手术治疗小细胞肺癌(small cell lung cancer,SCLC)的临床价值,并分析其临床特征。方法:回顾性分析2001年1月1日—2007年6月31日接受住院治疗的154例SCLC患者的临床资料。采用Kaplan-Meier曲线和log-rank检验进行生存分析和比较,并应用COX多因素回归分析与生存相关的因素。结果:154例患者总的中位生存期为16.1个月,1年生存率为60.3%。其中,接受手术者30例(19.5%),未接受手术者124例(80.5%),中位生存期分别为18.3和14.7个月(P>0.05),1年生存率分别为62.8%和63.3%(P>0.05)。局限期SCLC接受手术患者的中位生存期(24.4个月)优于未接受手术患者(19.8个月),2组的1年生存率分别为70.0%和68.6%,但差异无统计学意义(P>0.05)。根据WHO TNM分期,Ⅰ期患者的1年生存率为100.0%;Ⅱ期13例患者中有6例接受手术治疗,接受手术与未接受者的中位生存期分别为30.2和26.6个月(P>0.05),1年生存率分别为66.7%和85.7%(P>0.05)。病理诊断类型(组织学诊断或细胞学诊断)、临床分期、吸烟史(≥400年支或<400年支)、神经元特异性烯醇化酶(neuron-specific enolase,NSE)(≥20 ng/mL或<20 ng/mL)和癌胚抗原(carcinoembryonic antigen,CEA)(≥5 ng/mL或<5 ng/mL)和生存相关。COX多因素分析发现,吸烟是SCLC的独立预后因素(P=0.003;95%可信区间:1.458～8.060)。结论:手术在早期SCLC治疗中具有一定价值,对早期SCLC患者可采取手术结合放化疗的综合治疗措施。

Objective：To evaluate the value of surgery in the treatment of small cell lung cancer（SCLC） and analyze its clinical features.Methods：Retrospective study was performed on the clinical data from 154 patients with SCLC who received therapy in Shanghai Chest Hospital during 1st Jan 2001 to 31th Jun 2007.Kaplan-Meier analysis and log-rank test were used for survival analysis and statistical comparison.For multivariate analysis,COX proportional hazards regression model was used to identify risk factors associated with the survival of the patients.Results：The overall median survival time（MST） was 16.1 months and 1-year survival rate was 60.3% for the 154 patients.The MST was 18.3 months for the 30 patients（19.5%） who received surgery and 14.7 months for the other 124 patients（80.5%） who received only chemotherapy（P〉0.05）.The 1-year survival rates were 62.8% and 63.3%,respectively（P0.05）.For the patients with limited stage SCLC,there was no significant difference in the MST and survival rate between the patients who received surgery than those who did not receive surgery（24.4 vs 19.8 months,70.0% vs 68.6%,P0.05）.According to WHO TNM staging system,the 1-year survival rate was 100.0% for the patients with stage Ⅰ SCLC.For the 13 patients with stage Ⅱ SCLC,the MST was 30.2 months for the 6 patients in surgery group and 26.6 months for those in non-surgery group（P〉0.05）.The 1-year survival rates were 66.7% and 85.7%,respectively（P〉0.05）.In survival analysis,5 survival-related factors were identified： pathological classification（histological or cytological examination）,clinical stage,smoking history（≥400 cigarettes·year or 400 cigarettes·year）,neuron-specific enolase（≥20ng/mL or 20 ng/mL） and carcinoembryonic antigen（≥5 ng/mL or 〈5 ng/mL）.In multivariate analysis,smoking（≥400 cigarettes per year） was the independent prognostic factor for SCLC（P=0.003,95%confidence interval： 1.458-8.060）.Conclusion：Surgery had certain value in the treatment of early-stage（stageⅠ） SCLC.Surgery combined with chemotherapy and radiotherapy was recommended for patients with early-stage（stageⅠ） SCLC.