小细胞肺癌的外科治疗需要重新审视

The surgical treatment of small cell lung cancer(SCLC) needs re-thinking

小细胞肺癌(SCLC)的分期尤其是局限期SCLC(LD-SCLC)宜采用TNM系统。应强化术前分期检查,尽力避免因诊断不足带来的无效手术。近期大样本回顾性研究表明,手术(+化疗)治疗早期SCLC的疗效可与早期非小细胞肺癌相媲美,动摇了"SCLC以化疗/放化疗为主要治疗手段"的概念。SCLC的手术以肺叶切除为最好,亚肺叶及全肺切除生存差于肺叶切除,但仍好于化疗/放化疗。术后需加入全身化疗,是否颅脑放疗视情况而定。所有这些发现急需大样本前瞻性随机对照研究加以证实。

TNM system should be used in the staging of small cell lung cancer(SCLC), especially in the limited stages of SCLC. Preoperative staging should be strengthened to avoid invalid operation due to insufficient diagnosis.Retrospective studies showed that the efficacy of surgery(+ chemotherapy) in early SCLC is comparable to the outcome of resection for early stage non-small cell lung cancer, which shakes the concept of "chemotherapy/chemoradiotherapy as the main treatment of SCLC". The best operative procedure of SCLC is lobectomy. Sub-lobectomy and pneumonectomy are inferior to that of lobectomy, but still better than chemotherapy/chemo-radiotherapy in terms to long term survival. All these findings need to be confirmed by large sample prospective randomized studies.