Shepherd F A, Ginsberg R J, Feld R, Evans W K, Johansen E
Department of Medicine, Toronto General Hospital, ON., Canada.
J Thorac Cardiovasc Surg. 1991 Mar;101(3):385-93.
Since 1977, 119 patients with limited small-cell lung cancer have undergone combined modality therapy including surgery at our institution. Seventy-nine patients (58 male, 21 female; median age 63 years) had surgery first, and 67 of these had adjuvant chemotherapy. Forty (27 male, 13 female; median age 59 years) had chemotherapy first, and 94% had a complete or partial response before the operation. Pretreatment staging revealed 69 stage I, 27 stage II, and 23 stage III tumors. Twenty-six patients required pneumonectomy, 88 lobectomy, and five had no resection. Four patients had gross and six had microscopic residual disease. Postoperative pathologic examination showed small-cell lung cancer only (n = 95), non-small-cell lung cancer (n = 3), mixed (n = 17), and no residual tumor (n = 4). Postoperative staging revealed 35 stage I, 36 stage II, and 48 stage IIIa tumors. The median survival of the entire group is 111 weeks and the projected 5-year survival rate is 39%. No survival difference was seen between patients treated with chemotherapy before the operation and those undergoing an initial operation followed by chemotherapy (p = 0.756). The median survival for patients with pathologic stage I disease has not been reached, and the projected 5-year survival rate is 51%. This is significantly better than for the patients with stage II (median 82 weeks, p = 0.001) or stage III (median 83 weeks, p = 0.001) disease, who have projected 5-year survival rates of 28% and 19%, respectively. Seven of the 12 patients who had no adjuvant chemotherapy remain alive at 6 to 48+ months. Sixty-seven patients have died (11 had no evidence of disease). Only 10 patients had a relapse in the primary site alone, seven at the primary and distant sites, and 39 only in distant sites. In summary, resection improves control at the primary site, and a significant proportion of patients with stage I (N0) disease achieve long-term survival and cure with combined modality therapy including surgery. Stage II and IIIa patients have survival predictions similar to stage IIIa non-small-cell lung carcinoma treated surgically.
自1977年以来，我院119例局限性小细胞肺癌患者接受了包括手术在内的综合治疗。79例患者（男58例，女21例；中位年龄63岁）先接受手术，其中67例接受了辅助化疗。40例患者（男27例，女13例；中位年龄59岁）先接受化疗，其中94%在手术前有完全或部分缓解。治疗前分期显示，69例为Ⅰ期肿瘤，27例为Ⅱ期肿瘤，23例为Ⅲ期肿瘤。26例患者需要进行全肺切除术，88例进行肺叶切除术，5例未行切除术。4例有肉眼可见的残留病灶，6例有显微镜下残留病灶。术后病理检查仅显示小细胞肺癌（n = 95）、非小细胞肺癌（n = 3）、混合型（n = 17）和无残留肿瘤（n = 4）。术后分期显示，35例为Ⅰ期肿瘤，36例为Ⅱ期肿瘤，48例为Ⅲa期肿瘤。整个组的中位生存期为111周，预计5年生存率为39%。术前接受化疗的患者与先接受手术再接受化疗的患者之间未观察到生存差异（p = 0.756）。病理Ⅰ期疾病患者的中位生存期尚未达到，预计5年生存率为51%。这明显优于Ⅱ期（中位生存期82周，p = 0.001）或Ⅲ期（中位生存期83周，p = 0.001）疾病患者，Ⅱ期和Ⅲ期疾病患者的预计5年生存率分别为28%和19%。12例未接受辅助化疗的患者中有7例在6至48 +个月时仍存活。67例患者死亡（11例无疾病证据）。仅10例患者仅在原发部位复发，7例在原发部位和远处复发，39例仅在远处复发。总之，手术切除可改善原发部位的控制，相当一部分Ⅰ期（N0）疾病患者通过包括手术在内的综合治疗可实现长期生存和治愈。Ⅱ期和Ⅲa期患者的生存预测与手术治疗的Ⅲa期非小细胞肺癌患者相似。
