Zhang Chao, Yang Haitang, Zhao Heng, Lang Baoping, Yu Xiangdong, Xiao Peng, Zhang Xiao
Department of Thoracic Surgery, The Affiliated Luoyang Central Hospital of Zhengzhou University, Luoyang 471000, China.
Department of Thoracic Surgery, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai 200030, China;; Division of General Thoracic Surgery, Inselspital University Hospital Bern, Bern, Switzerland;; Department of Clinical Research, University of Bern, Bern, Switzerland;; Graduate School for Cellular and Biomedical Sciences, University of Bern, Bern 3010, Switzerland.
J Thorac Dis. 2017 Jan;9(1):151-158. doi: 10.21037/jtd.2017.01.07.
The combined small cell lung cancer (c-SCLC) was rare and its clinicopathological characteristics had not been thoroughly described. The aim of this study was to determine prognostic factors and survival in c-SCLC patients.
Clinical records of patients with c-SCLC who underwent surgery between January 2009 and December 2013 in two institutions were retrospectively reviewed.
Ninety-seven patients were identified. The most common pathology was combined SCLC and large cell neuroendocrine carcinoma (LCNEC, N=46), followed by combined SCLC and squamous cell carcinoma (SCC) (N=32), combined SCLC and adenocarcinoma (AC) (N=12), and combined SCLC and adenosquamous carcinoma (ASC) (N=7). The overall survival (OS) rates of the entire cohort were 42.4% and 35.2% at 3 and 5 years, respectively. Multivariate analysis identified sex [female male, hazards ratio (HR) =0.38; 95% confidence interval (CI): 0.19-0.79; P=0.010], age (<53 >53 years, HR =0.28; 95% CI: 0.09-0.81; P=0.019), performance status (<2 >2, HR =0.08; 95% CI: 0.02-0.32; P<0.001), combined non-small cell lung cancer (NSCLC) components (LCNEC non-LCNEC, HR =3.00; 95% CI: 1.03-8.76; P=0.045), adjuvant therapy (yes no, HR =0.33; 95% CI: 0.17-0.67; P=0.002) as significantly prognostic factors of OS in patients with complete resection and lymphadenectomy.
The mixed NSCLC components within c-SCLCs had a significant influence on the survival. Compared with surgery alone, adjuvant therapy was associated with significantly improved survival in patients with complete resection and lymphadenectomy.
合并小细胞肺癌（c-SCLC）较为罕见，其临床病理特征尚未得到充分描述。本研究旨在确定c-SCLC患者的预后因素和生存率。
回顾性分析2009年1月至2013年12月在两家机构接受手术的c-SCLC患者的临床记录。
共纳入97例患者。最常见的病理类型是合并小细胞肺癌和大细胞神经内分泌癌（LCNEC，n = 46），其次是合并小细胞肺癌和鳞状细胞癌（SCC，n = 32）、合并小细胞肺癌和腺癌（AC，n = 12）以及合并小细胞肺癌和腺鳞癌（ASC，n = 7）。整个队列的3年和5年总生存率（OS）分别为42.4%和35.2%。多因素分析确定，对于接受了完整切除和淋巴结清扫的患者，性别（女性对男性，风险比[HR]=0.38；95%置信区间[CI]：0.19-0.79；P = 0.010）、年龄（<53岁对>53岁，HR = 0.28；95% CI：0.09-0.81；P = 0.019）、体能状态（<2对>2，HR = 0.08；95% CI：0.02-0.32；P<0.001）、合并的非小细胞肺癌（NSCLC）成分（LCNEC对非LCNEC，HR = 3.00；95% CI：1.03-8.76；P = 0.045）、辅助治疗（是对否，HR = 0.33；95% CI：0.17-0.67；P = 0.002）是OS的显著预后因素。
c-SCLC中的混合NSCLC成分对生存率有显著影响。与单纯手术相比，辅助治疗与接受完整切除和淋巴结清扫的患者生存率显著提高相关。
