Yale University School of Medicine, Department of Surgery, Section of Thoracic Surgery, New Haven, CT, USA.
Yale University School of Medicine, Department of Surgery, Section of Thoracic Surgery, New Haven, CT, USA.
Lung Cancer. 2017 Jan;103:75-81. doi: 10.1016/j.lungcan.2016.11.016. Epub 2016 Nov 28.
A proportion of patients with clinical stage I small cell lung cancer (SCLC) will be upstaged following surgical resection. The existing data regarding the management of upstaged SCLC patients and guidelines for their treatment remains sparse. The primary objective was to describe the impact of pathologic upstaging following surgical resection.
The National Cancer Database was queried for patients with clinical stage I SCLC (cT1-2a,N0,M0) who underwent resection with curative intent followed by adjuvant therapy, excluding patients who underwent surgery alone. Clinical and pathologic T, N, and M staging were compared to identify patients that were upstaged.
Four-hundred and seventy-seven patients were identified with clinical stage I SCLC. Pathologic upstaging occurred in 25% (117). Of those upstaged, 30% (35) were due to a higher pathologic T descriptor and 81% (95) were due to the presence of nodal disease. Overall 5-year survival was significantly worse for upstaged patients compared with those patients who remained a pathologically stage I (36% vs 52%, p<0.001). Among patients with positive lymph node involvement, adjuvant chemotherapy and radiation therapy was associated a significantly improved 5-year survival compared to adjuvant chemotherapy alone (20% vs 55%, respectively, p<0.01). The use of adjuvant chemotherapy and radiation therapy in patients with nodal disease after surgical resection was an independent predictor of improved survival (HR 0.36, 95% CI 0.18-0.73, p<0.01).
Pathologic upstaging is common after surgical resection of stage I SCLC, and is associated with significantly inferior survival. These data provide evidence that recommend the use of adjuvant chemotherapy and radiation therapy in the setting of nodal upstaging after resection of clinical stage I SCLC patients.
一部分临床 I 期小细胞肺癌（SCLC）患者在接受手术切除后会出现分期升级。目前关于 SCLC 分期升级患者的管理以及治疗指南的数据仍然很少。本研究的主要目的是描述手术切除后病理分期升级的影响。
本研究通过国家癌症数据库，检索了临床 I 期 SCLC（cT1-2a，N0，M0）患者的资料，这些患者接受了以治愈为目的的切除术，并接受了辅助治疗，但不包括单独接受手术的患者。通过比较临床和病理 T、N 和 M 分期，确定分期升级的患者。
共确定了 477 例临床 I 期 SCLC 患者。病理分期升级发生率为 25%（117 例）。在这些分期升级的患者中，30%（35 例）是由于更高的病理 T 描述，81%（95 例）是由于存在淋巴结疾病。与病理分期仍为 I 期的患者相比，分期升级的患者 5 年总生存率显著降低（36% vs 52%，p<0.001）。在有阳性淋巴结受累的患者中，与单独接受辅助化疗相比，辅助化疗加放疗显著提高了 5 年生存率（分别为 20%和 55%，p<0.01）。手术后淋巴结疾病患者使用辅助化疗和放疗是生存改善的独立预测因素（HR 0.36，95%CI 0.18-0.73，p<0.01）。
手术切除后病理分期升级在临床 I 期 SCLC 中很常见，且与生存率显著降低相关。这些数据为在切除临床 I 期 SCLC 患者后淋巴结分期升级的情况下，推荐使用辅助化疗和放疗提供了证据。
