肺大细胞神经内分泌癌41例治疗及预后分析

An Analysis of the Treatment and Prognosis in 41 Cases with Large Cell Neuroendocrine Lung Carcinoma

[目的]对肺大细胞神经内分泌癌的临床资料进行总结,分析影响其预后的因素,探索更有效的治疗方法。[方法]通过查阅病历记录及电话随访收集自1991年1月至2013年3月期间本院41例病理确诊为肺大细胞神经内分泌癌患者的资料,并进行回顾性研究,用SPSS19.0软件Kaplan-Meier法进行生存分析,Cox回归进行多因素分析。[结果 ]N0期、N1期、N2期5年总生存率分别为72%、70.1%、29.2%(P=0.048)。综合治疗和单纯手术治疗5年无瘤生存率分别为68.4%、28.2%(P=0.043),单纯手术治疗组的复发率为63.16%(12/19),综合治疗组复发率为30%(6/20)(P=0.040),复发患者接受再次治疗与未接受再次治疗的5年生存率分别为66.7%和11.1%(P=0.039)。[结论]N分期与肺大细胞神经内分泌癌患者预后明确相关,手术及术后含铂药物辅助化疗的综合治疗能够延长肺大细胞神经内分泌癌患者的无瘤生存时间、降低复发率。复发患者进行再次化疗和(或)放疗可进一步提高远期生存率。

[Purpose] To investigate the clinical character of the large cell neuroendocrine lung carcinoma（1,CNEC）,and to analyze the factors related to prognosis,and to explore better treatment fi^r LCNEC. [Methods] The data of 41 pathologically confirmed LCNEC patients from January 1999 to March 2013 in our hospital was collected and analyzed retrospectively. The survival anal- ysis was evaluated using the method of Kaplan-Meier by SPSS 19.0 software. Cox regression was used for muhivariate analysis. [Results] The 5-year survival in stage N0,Nj ,N2 was 72%,70.1%, 29.2% respectively （P=0.048）.The 5-year disease free survival rate was 68.4% in comprehensive treatment group and 28.2% in surgery alone group with significant difference（P=0.043）. The relapse rate was 63.16% （ 12/19 ） in surgery, alone group and 30% （6/20） in comprehensive treatment group （P=0.040）,The 5-year survival rate of relapsed patients in retreated group and non-retreated group was 66.7% and 11.1%（P=0.039）. [Conclusions] N stage is obviously related to the prognosis of LCNEC. Comprehensive treatments including surgery and platinum-based adjuvant chemotherapy are able to prolong the disease l}＇ee survival and reduce recurrence rate for LCNEC patients. Re- chemotherapy and （or） radiotherapy can fllrther improve the long-term survival in relapsed patients of LCNEC.