复合性小细胞肺癌临床病理学特征及预后分析

Clinicopathological Characteristics and Prognosis of Combined Small Cell Lung Cancer

目的:探讨复合性小细胞肺癌(combined small cell lung cancer,CSCLC)临床病理学特征及其与预后的关系。方法:收集天津医科大学附属肿瘤医院2006年1月至2008年12月入院治疗行根治性手术切除并经病理证实为CSCLC病例44例,重新审阅肿物病理切片,回顾性分析其临床及病理学特征,Kaplan-Meier法计算生存率并描绘生存曲线,Cox风险回归模型分析影响总生存期(overall survival,OS)及无瘤生存期(disease-free survival,DFS)的独立因素.结果:全组CSCLC患者OS为6～57个月,中位OS为20个月;DFS为3～57个月,平均14.5个月。Kaplan-Meie r生存曲线显示,女性DFS长于男性,肿瘤位置、小细胞癌复合成分病理类型对OS有影响(P<0.05)。多因素分析显示,肿瘤位于左肺或右肺及复合成分病理类型为影响患者OS的危险因素,未发现影响患者术后DFS的危险因素。结论:CSCLC属于一种特殊类型的肺混合性癌,治疗应采取以手术为主的综合治疗方案,判定其复合成分的病理类型对于临床上判断预后具有重要的意义。

Objective： To explore the relationship between the clinicopathological characteristics and prognostic factors of the combined small cell lung cancer （ CSCLC ）. Methods： The clinical data of 44 CSCLC patients who underwent radical surgery in Tianjin Medical University Cancer Institute and Hospital between January 2006 and December 2008 were reviewed. The pathological sections were rechecked, and clinicopathologic features of CSCLC were retrospectively analyzed. The Kaplan-Meier method was used to calculate the survival rate and depict the survival curves. The Cox regression model was used to analyze the independent factors affecting the overall survival （ OS ） and disease-free survival （ DFS ）. Results： The median OS of the CSCLC patients in all groups was 20 months, whereas the OS ranged from 6 to 57 months. DFS ranged from 3 to 57 months, with an average of 14.5 months. The overall 1- and 3-year survival rates were 75.6% and 21.3%, respectively. The Kaplan-Meier survival curves revealed that, compared with males, female patients had a longer DFS time, and that the OS time was affected by the tumor location and the pathological types of the morphologic constituents （ P〈 0.05 ）. The Cox multivariate analysis showed that the tumor location and pathomorphological classification of the composite components were independent prognostic factors for the OS of the patients. The risk factors that influenced the postoperative DFS of tile patients were not found. Conclusion： CSCLC is a special mixed carcinoma. Combined therapy with surgery as the first-line treatment should be adopted in the therapeutic regimen of this disease. Correct judgment of the pathologic types is significant in determining the clinical prognosis.