小细胞癌和鳞状细胞癌复合型肺癌术后化疗的意义

Clinical value of postoperative chemotherapy for combined small cell and squamous cell lung cancer

目的：探讨小细胞癌和鳞状细胞癌复合型肺癌术后化疗的意义。方法：选择天津市胸科医院2004年5月—2012年4月经术后病理确诊为小细胞癌和鳞状细胞癌复合型肺癌的50例患者,回顾性分析其临床资料,并以术后是否化疗分为化疗组与无化疗组。采用Kaplan-Meier法计算生存率并描绘生存曲线,log-rank法进行生存检验和预后的单因素分析。采用COX风险回归模型进行预后的多因素分析。结果：50例小细胞癌和鳞状细胞癌复合型肺癌患者的无进展生存期为2～40个月,平均为14个月。单因素分析结果显示,肿瘤位于左肺还是右肺（P=0.010）、淋巴结有无转移（P=0.013）、术后有无化疗（P=0.009）和N分期（P=0.001）对无进展生存的影响有统计学意义。COX比例风险回归模型显示,N分期（风险比为5.460,95%可信区间：2.007～14.852,P=0.001）及术后化疗（风险比为0.317,95%可信区间：0.126～0.800,P=0.015）是影响无进展生存的独立危险因素。结论：小细胞癌和鳞状细胞癌复合型肺癌是一种小细胞肺癌的特殊亚型,对其治疗应完善相关术前检查,根据TNM分期认真地进行术前评估,对于有手术指征的早期患者,手术切除后辅以化疗能够改善其预后。

Objective：To explore the clinical value of postoperative chemotherapy for combined small cell and squamous cell lung cancer.Methods：The data of 50 patients with combined small cell and squamous cell lung cancer who underwent radical surgery in Tianjin Chest Hospital between May 2004 and April 2012 were collected and a retrospective study of the clinical features was performed.The patients were divided into post-operative chemotherapy group and no-chemotherapy group.The Kaplan-Meier method was used to calculate the survival rate and depict the survival curves.The log-rank test was used to compare the survival and perform the univariate analysis of prognostic factors.The COX regression model was used to analyze the multivariate survival factors.Results：For fifty patients with combined small cell and squamous cell lung cancer,the progression-free survival（PFS） ranged from 2 to 40 months（median PFS：14 months）.The Kaplan-Meier survival curves revealed that the PFS was affected by the tumor location（left or right;P = 0.010）,lymph node metastasis（yes or no;P = 0.01 3）,post-operative chemotherapy（yes or no;P = 0.009） and N staging（P = 0.001）.The COX multivariate analysis showed that N staging（hazard ratio：5.460,95%confidence interval：2.007-14.852,P = 0.001） and post-operative chemotherapy（hazard ratio：0.31 7,95%confidence interval：0.126-0.800,P = 0.01 5） were independent prognostic factors for PFS of the patients.Conclusion：The combined small cell and squamous cell lung cancer is a special subtype of small cell lung cancer.The preoperative examination should be improved and the pre-operative evaluation should be performed seriously according to TNM staging.For early stage patients with surgical indications,post-operative chemotherapy may improve the prognosis.