Department of Cardiothoracic Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania 15213, USA.
Ann Thorac Surg. 2012 Sep;94(3):889-93. doi: 10.1016/j.athoracsur.2012.01.015. Epub 2012 Mar 17.
Small cell lung carcinoma (SCLC) is rarely treated with resection, either alone or combined with other modalities. This study evaluated the role of surgical resection in the treatment of stage I and II SCLC.
We queried the Surveillance, Epidemiology, and End Results (SEER) database for patients from 1988 to 2007 with SCLC. Survival was determined by Kaplan-Meier analysis and compared using the log-rank test. A Cox proportional hazard model identified relevant survival variables.
We identified 3,566 patients with stage I or II SCLC. Lung resection was performed in 895 (25.1%), wedge resection in 251 (28.0%), lobectomy or pneumonectomy in 637 (71.2%), and lung resection not otherwise specified in 7 (0.78%). Median survival was 34.0 months (95% confidence interval [CI], 29.0 to 39.0 months) vs 16.0 months (95% CI, 15.3 to 16.7; p<0.001) in nonsurgical patients. Median survival after lobectomy or pneumonectomy was 39.0 months (95% CI, 30.7 to 40.3) and significantly longer than after wedge resection (28.0 months; 95% CI, 23.2 to 32.8; p=0.001). However, survival after wedge resection was still significantly longer than survival in nonsurgical patients (p<0.001). Sex (p=0.013), age, stage at diagnosis, radiotherapy, and operation (all p<0.001) significantly affected survival. In the surgical patients, sex (p=0.001), age (p<0.001), final stage (p<0.001), and type of resection (p=0.01) were important determinants of survival.
Surgical resection as a component of treatment for stage I or II SCLC is associated with significantly improved survival and should be considered in the management of early-stage SCLC.
小细胞肺癌（SCLC）很少单独或与其他方法联合进行切除术治疗。本研究评估了手术切除在 I 期和 II 期 SCLC 治疗中的作用。
我们从 1988 年至 2007 年在 SEER 数据库中查询患有 SCLC 的患者。通过 Kaplan-Meier 分析确定生存情况，并使用对数秩检验进行比较。Cox 比例风险模型确定了相关的生存变量。
我们确定了 3566 例 I 期或 II 期 SCLC 患者。进行了肺切除术 895 例（25.1%），楔形切除术 251 例（28.0%），肺叶切除术或全肺切除术 637 例（71.2%），未特指的肺切除术 7 例（0.78%）。非手术患者的中位生存时间为 34.0 个月（95%置信区间[CI]，29.0 至 39.0 个月），而手术患者的中位生存时间为 16.0 个月（95% CI，15.3 至 16.7；p<0.001）。肺叶切除术或全肺切除术的中位生存时间为 39.0 个月（95% CI，30.7 至 40.3），明显长于楔形切除术（28.0 个月；95% CI，23.2 至 32.8；p=0.001）。然而，楔形切除术的生存时间仍然明显长于非手术患者（p<0.001）。性别（p=0.013）、年龄、诊断时的分期、放疗和手术（均 p<0.001）显著影响生存。在手术患者中，性别（p=0.001）、年龄（p<0.001）、最终分期（p<0.001）和切除类型（p=0.01）是生存的重要决定因素。
作为 I 期或 II 期 SCLC 治疗的一部分，手术切除与显著改善的生存相关，应在早期 SCLC 的治疗管理中考虑。
