Shepherd F A, Evans W K, Feld R, Young V, Patterson G A, Ginsberg R, Johansen E
Department of Medicine, University of Toronto, Ontario, Canada.
J Clin Oncol. 1988 May;6(5):832-8. doi: 10.1200/JCO.1988.6.5.832.
Surgery alone is inadequate therapy for limited small-cell lung cancer (SCLC), resulting in less than 5% long-term survival. Since 1976, we treated patients undergoing surgery for SCLC with adjuvant chemotherapy in an attempt to prolong survival and increase cure. Seventy-seven patients who underwent surgery as their primary treatment were identified, and of these 63 (46 male and 17 female) received chemotherapy. Fifteen patients had a pneumonectomy, 46 a lobectomy, and two had wedge resections. Six patients had positive microscopic resection margins. Pathologic staging showed tumor, node, metastasis (TNM) involvement as follows: T1N0, eight; T2N0, ten; T1N1, six; T2N1, 18; T1N2, five; T2N2, nine; T3N0, three; T3N1, one; and T3N2, three. All patients received cyclophosphamide, Adriamycin (doxorubicion; Adria Laboratories, Mississauga, Ontario), and vincristine; four also received etoposide (VP-16) and cisplatin, one VP-16, and four methotrexate, procarbazine, and lomustine (CCNU). Forty-nine patients received prophylactic cranial irradiation, and 35 received radiotherapy to the mediastinum and primary site. The overall median survival of the 63 patients is 83 weeks, and the projected 5-year survival is 31%. Patients with T1 or T2 tumors without nodal involvement had a median survival of 191 weeks, and projected 5-year survival of 48%. Stage II (T1N1, T2N1) and stage III (any T3 or T1-2N2) patients had median survivals of 72 weeks and 65 weeks, and projected 5-year survivals of 24.5% and 24%, respectively. Thirty-three patients have relapsed and died of disease. Only two patients had an isolated relapse at the primary site. Seven other patients have died without recurrent disease. Adjuvant chemotherapy after surgery results in prolonged survival and cure for a significant number of patients with stage I SCLC, although nodal involvement at any level is associated with shorter survival.
单纯手术对于局限性小细胞肺癌（SCLC）来说是不充分的治疗方法，长期生存率低于5%。自1976年以来，我们对接受SCLC手术的患者进行辅助化疗，以试图延长生存期并提高治愈率。确定了77例接受手术作为主要治疗的患者，其中63例（46例男性和17例女性）接受了化疗。15例行全肺切除术，46例行肺叶切除术，2例行楔形切除术。6例患者显微镜下切除边缘阳性。病理分期显示肿瘤、淋巴结、转移（TNM）情况如下：T1N0，8例；T2N0，10例；T1N1，6例；T2N1，18例；T1N2，5例；T2N2，9例；T3N0，3例；T3N1，1例；T3N2，3例。所有患者均接受环磷酰胺、阿霉素（多柔比星；阿德里亚实验室，安大略省密西沙加）和长春新碱治疗；4例还接受了依托泊苷（VP - 16）和顺铂治疗，1例接受VP - 16治疗，4例接受甲氨蝶呤、丙卡巴肼和洛莫司汀（CCNU）治疗。49例患者接受了预防性颅脑照射，35例接受了纵隔和原发部位放疗。63例患者的总体中位生存期为83周，预计5年生存率为31%。T1或T2期无淋巴结受累的患者中位生存期为191周，预计5年生存率为48%。II期（T1N1、T2N1）和III期（任何T3或T1 - 2N2）患者的中位生存期分别为72周和65周，预计5年生存率分别为24.5%和24%。33例患者复发并死于疾病。仅2例患者在原发部位出现孤立性复发。另外7例患者未复发而死亡。手术后辅助化疗可使相当数量的I期SCLC患者生存期延长并治愈，尽管任何水平的淋巴结受累均与较短生存期相关。
