Sahmoun Abe E, Case L Douglas, Santoro Thomas J, Schwartz Gary G
University of North Dakota School of Medicine, Fargo, ND 58102, USA.
Anticancer Res. 2005 Mar-Apr;25(2A):1101-8.
Primary small cell lung cancer (SCLC) has a predilection for the right rather than the left lung. The aim of this study was to examine the association between gender and pulmonary location and to examine the effects of these variables on the incidence of brain metastasis and the survival rate of patients with SCLC.
We conducted a retrospective review of medical charts of patients diagnosed with SCLC between January 1989 and December 2002 at MeritCare Hospital in Fargo, ND, USA. The effects of the anatomical site of SCLC, age, gender, body mass index, stage of SCLC and treatment of SCLC on the incidence of brain metastasis and survival were examined using univariate and multivariable Cox proportional-hazards regression models.
Two-hundred and thirty patients were identified with SCLC. One hundred and forty-eight (64%) were male and 82 (36%) were female. SCLC was significantly more common in the right upper lobe for females (51%) than for males (32%) (p-value=0.005) and in the left upper lobe for males (28%) compared to females (11%) (p-value=0.003). Survival was significantly longer in both younger patients (48 weeks vs. 26 weeks; log-rank p-value=0.03) and female patients (50 weeks vs. 36 weeks; log-rank p-value=0.01). The multivariable Cox model showed an adjusted HR of 1.52 (95% confidence interval 1.01-2.3) for the right lung relative to the left lung. We found no impact of anatomical distribution or pulmonary location on the incidence of brain metastasis.
In these data, SCLC is more common in the right upper lobe for females. Right lung and male gender are associated with a worse prognosis, which may suggest that more aggressive therapy is needed in these patients.
原发性小细胞肺癌（SCLC）更易发生于右肺而非左肺。本研究旨在探讨性别与肺部位置之间的关联，并研究这些变量对SCLC患者脑转移发生率和生存率的影响。
我们对1989年1月至2002年12月期间在美国北达科他州法戈市梅里特医院诊断为SCLC的患者病历进行了回顾性研究。使用单变量和多变量Cox比例风险回归模型，研究SCLC的解剖部位、年龄、性别、体重指数、SCLC分期和SCLC治疗对脑转移发生率和生存率的影响。
共确定230例SCLC患者。其中148例（64%）为男性，82例（36%）为女性。女性SCLC在右上叶的发生率（51%）显著高于男性（32%）（p值=0.005），男性SCLC在左上叶的发生率（28%）高于女性（11%）（p值=0.003）。年轻患者（48周对26周；对数秩p值=0.03）和女性患者（50周对36周；对数秩p值=0.01）的生存期显著更长。多变量Cox模型显示，右肺相对于左肺的调整后风险比为1.52（95%置信区间1.01-2.3）。我们发现解剖分布或肺部位置对脑转移发生率没有影响。
在这些数据中，女性SCLC在右上叶更为常见。右肺和男性性别与较差的预后相关，这可能表明这些患者需要更积极的治疗。
