Department of Radiation Oncology, State University of New York Downstate Medical Center, Brooklyn, NY, USA.
Cancer. 2010 Mar 1;116(5):1350-7. doi: 10.1002/cncr.24853.
Although chemotherapy and radiation therapy currently are recommended in limited-stage small cell lung cancer (L-SCLC), several small series have reported favorable survival outcomes in patients who underwent surgical resection. The authors of this report used a US population-based database to determine survival outcomes of patients who underwent surgery.
The Surveillance, Epidemiology, and End Results (SEER) registry was used to identify patients who were diagnosed with L-SCLC between 1988 and 2002 coded by SEER as localized disease (T1-T2Nx-N0) or regional disease (T3-T4Nx-N0). Kaplan-Meier and Cox regression analyses were used to compare overall survival (OS) for all patients.
In total, 14,179 patients were identified, including 863 patients who underwent surgical resection. Surgery was associated more commonly with T1/T2 disease (P < .001). Surgery was associated with improved survival for both localized disease and regional disease with improvements in median survival from 15 months to 42 months (P < .001) and from 12 months to 22 months (P < .001), respectively. Lobectomy was associated with the best outcome (P < .001). Patients with localized disease who underwent lobectomy with had a median survival of 65 months and a 5-year OS rate of 52.6%; whereas patients who had regional disease had a median survival of 25 months and a 5-year OS rate of 31.8%. On multivariate analysis, the benefit of surgery varied in a time-dependant fashion. However, the benefit of lobectomy remained across all time intervals (P = .002).
The use of surgery, and particularly lobectomy, in selected patients with L-SCLC was associated with improved survival outcomes. Future prospective studies should consider the role of surgery as part of the multimodality management of this disease.
尽管化疗和放疗目前被推荐用于局限期小细胞肺癌（L-SCLC），但有几个小系列报道了接受手术切除的患者的生存结果良好。本报告的作者使用美国基于人群的数据库来确定接受手术的患者的生存结果。
使用监测、流行病学和最终结果（SEER）登记处来确定 1988 年至 2002 年间被 SEER 编码为局限性疾病（T1-T2Nx-N0）或区域性疾病（T3-T4Nx-N0）的诊断为 L-SCLC 的患者。采用 Kaplan-Meier 和 Cox 回归分析比较所有患者的总生存率（OS）。
共确定了 14179 例患者，其中 863 例患者接受了手术切除。手术更常见于 T1/T2 疾病（P<0.001）。手术与局部疾病和区域疾病的生存改善相关，中位生存时间从 15 个月延长至 42 个月（P<0.001）和从 12 个月延长至 22 个月（P<0.001）。肺叶切除术与最佳结果相关（P<0.001）。接受肺叶切除术的局限性疾病患者的中位生存时间为 65 个月，5 年 OS 率为 52.6%；而区域性疾病患者的中位生存时间为 25 个月，5 年 OS 率为 31.8%。多变量分析显示，手术的益处随时间呈时间依赖性变化。然而，肺叶切除术的益处仍然存在于所有时间间隔（P=0.002）。
在选定的局限期小细胞肺癌患者中使用手术，特别是肺叶切除术，与改善生存结果相关。未来的前瞻性研究应考虑手术作为该疾病多模式治疗的一部分。
