Ⅱ～ⅢA期小细胞肺癌外科治疗临床研究

Ⅱ ～ ⅢA stage small cell lung cancer surgery clinical research

目的本研究通过对Ⅱ~ⅢA期小细胞肺癌（small cell lung cancer,SCLC）患者以手术治疗参与的综合治疗组与单纯放化疗组疗效的比较,探讨外科手术是否能使这类患者受益。方法回顾性分析本院收治经病理证实SCLC患者902例,对其中分期Ⅱ~ⅢA期SCLC患者共268例入组分析,其中以手术治疗为主的综合治疗组129例,单纯放化疗组139例。两组患者均进行全身化学治疗,方案为依托泊苷＋顺铂（EP方案）或卡铂＋依托泊苷（CE）方案,少数采用环磷酰胺＋多柔比星＋顺铂（CAP）及环磷酰胺＋长春新碱＋表阿霉素（COA）方案,治疗2~10个周期。手术组患者采取以肺叶切除及复合肺叶切除为主的根治性手术（75.97%）,少部分采取姑息性切除（楔形切除）（7.75%）。入组患者部分行胸部放疗＋全脑预防照射,行放射治疗患者采取化疗＋放疗＋化疗序贯治疗。结果外科治疗组患者1年、2年、3年及5年生存率为90.70%、70.54%、52.71%及33.78%（25/74）;非外科治疗组患者1年、2年、3年及5年生存率为82.73%、58.27%、43.17%及25.35%（18/71）。影响生存期的主要原因为肿瘤的局部复发及大脑、骨及全身其他器官转移。两组患者应用Kaplan Meier生存分析曲线分析显示P〈0.05,差异有显著性。结论在Ⅱ~ⅢA期SCLC中对于能够外科治疗的患者,外科治疗能够延长患者生存周期,其生存率优于非手术组,辅助术前及术后化学治疗及局部放疗可以获得较好的临床治疗效果。

Objective By comparing the outcome of surgical resection combining with chemo-radiotherapy and simply chemo-radiotherapy, this study evaluate the role of surgical resection in the treatment of stage Ⅱ～Ⅲ A SCLC. Method We analyze the database of 902 SCLC patients received in CICAMS from January 2004 to December 2011 retrospectively. Of 268 cases are Ⅱ～ⅢA stage. Surgical resection were performed in 129 of them, the rest of 139 case are treated without surgery. They both received chemotherapy, the chemical regimen included etoposide＋cis- platinum （PE） or carboplatin＋etoposide （CE） 2 - 10 cycles, small part of them received cyclophosphamide＋doxorubi- cin＋cis-platinum（CAP） or cyclophosphamide＋vincristine＋pharmorubicin （COA） 2 ~ 10 cycles . The resection gave priority to radical resection including lobectomy and bilobectomy （75.97%）, a small part of it was palliative resec- tion （ wedge resection） （7.75%）. Part of patients were treated with thoracic irradiation and prophylactic cranial irra- diation （PCI） ,with sequential chemotherapy. Result In surgery group,the 1 year, 2 years, 3 years and 5 years sur- vival rates were 90.70% ,70.54% ,52.71% and 33.78% （25/74）. In non-surgery group, the 1 year, 2 years, 3 years and 5 years survival rates were 82.73% ,58.27% ,43.17% and 25.35% （ 18/71 ）. Failure in both group in- cluded local recurrence, distant metastasis and brain metastasis . By analyzing the database with Kaplan Meier sur- vival analysis, the surgical group had better prognosis than the non-surgical group . Conclusion In stage Ⅱ～Ⅲ A SCLC patients who is suitable for surgical resection, the operation therapy would benefit the patients, combining with chemotherapy and radiotherapy would achieve a satisfactory treatment result.