Mangum M D, Greco F A, Hainsworth J D, Hande K R, Johnson D H
Department of Medicine, Vanderbilt University Medical Center, Nashville, TN.
J Clin Oncol. 1989 May;7(5):607-12. doi: 10.1200/JCO.1989.7.5.607.
Nine (2%) of 429 small-cell lung cancer (SCLC) patients seen at Vanderbilt University between 1977 and 1983 had a combined subtype SCLC at diagnosis (ie, small-cell carcinoma plus squamous cell or adenocarcinoma). Staging procedures and chemotherapy treatment were uniform for all 429 patients. The diagnosis of combined histology was established via bronchoscopy (six patients), needle aspiration biopsy (one), lymph node biopsy (one), and thoracotomy (one). The clinical characteristics of the combined subtype patients were similar to patients with other subtypes of SCLC (ie, there were no differences in median age, sex, performance status, and stage of disease). However, patients with a combined subtype histology had a higher incidence of peripheral lesions on chest x-ray (56% v 14%, P less than .001) and a lower median lactate dehydrogenase (LDH) (301 IU/L v 341 IU/L, P = .0002) at diagnosis. The overall response to chemotherapy (57% v 78; P = .5) and the median survival (8 months v 10 months; P = .4) of the combined subtype patients were similar to patients with other subtypes of SCLC. Two (22%) combined histology patients survived greater than or equal to 5 years. Both had had surgical resection in addition to chemotherapy. These data suggest that the combined subtype of SCLC is clinically similar to pure SCLCs and that surgery may play a prominent role in the management of these tumors. The possibility of a combined histology tumor should be considered in patients thought to have SCLC on the basis of limited biopsy material, such as a needle aspiration or bronchial biopsy, and when the primary lesion is peripherally located on chest x-ray.
1977年至1983年间在范德堡大学就诊的429例小细胞肺癌（SCLC）患者中，有9例（2%）在诊断时为混合型SCLC（即小细胞癌合并鳞状细胞癌或腺癌）。所有429例患者的分期检查程序和化疗方案均一致。混合型组织学诊断通过支气管镜检查（6例患者）、针吸活检（1例）、淋巴结活检（1例）和开胸手术（1例）得以确立。混合型患者的临床特征与其他亚型SCLC患者相似（即中位年龄、性别、体能状态和疾病分期无差异）。然而，混合型组织学患者在诊断时胸部X线显示周围性病变的发生率较高（56%对14%，P<0.001），且中位乳酸脱氢酶（LDH）较低（301 IU/L对341 IU/L，P = 0.0002）。混合型患者对化疗的总体反应率（57%对78%；P = 0.5）和中位生存期（8个月对10个月；P = 0.4）与其他亚型SCLC患者相似。2例（22%）混合型组织学患者存活时间≥5年。二者除接受化疗外均接受了手术切除。这些数据表明，混合型SCLC在临床上与纯SCLC相似，手术可能在这些肿瘤的治疗中发挥重要作用。对于基于有限活检材料（如针吸或支气管活检）被认为患有SCLC且胸部X线显示原发灶位于周围的患者，应考虑混合型组织学肿瘤的可能性。
