Zeng Haikang, Liu Yang, Xia Xiaojun, Li Jin, He Jianxing
Department of Thoracic Surgery, the First Affiliated Hospital of Guangzhou Medical University, Guangzhou 510120, China.
State Key Laboratory of Respiratory Disease, the First Affiliated Hospital of Guangzhou Medical University, Guangzhou 510120, China.
Zhongguo Fei Ai Za Zhi. 2018 Jan 20;21(1):8-15. doi: 10.3779/j.issn.1009-3419.2018.01.02.
Currently, the prognosis of lobectomy and sub-lobectomy for the treatment of stage Ia small cell lung cancer (SCLC) is rarely reported. We retrospectively studied T1N0M0 (≤3 cm) SCLC patients aged ≥60 years, aiming to comparatively analyze the prognosis of lobectomy and sub-lobectomy in treating patients with Ia SCLC.
Patients with stage Ia SCLC diagnosed by pathologic between 1992 and 2010 were selected from the "Surveillance, Epidemiology and End Results database"(SEER). Outcome data were compared using Kaplan-Meier (Log-rank test) and Cox model multivariate analysis.
We identified 515 patients. Median overall survival (OS) of the lobectomy (n=110), sublobar resection (n=57) and non-surgical (n=348) cohort were 45, 23 and 16 months, respectively. The corresponding 5-year OS of the three groups were 44%, 30%, and 14%, respectively. No significant difference in the prognosis of patients with or without lymph node examination/ dissection (P=0.107) and the 5-year OS of patients underwent lobectomy with chemoradiation was 50%. Cox multivariable analysis showed that operation treatment, including lobectomy and sublobectomy, was one of the independent factors associated with the prognosis of early SCLC patients, and patients undergo lobectomy shows a better OS compared with sublobar resection (Lob vs Sub, HR=0.645; 95%CI: 0.433-0.961, P=0.031).
For age ≥60 years T1N0M0 (≤3 cm) SCLC patients, we recommend anatomical lobectomy combined with adjuvant chemoradiation.
目前，关于肺叶切除术和肺叶下切除术治疗Ⅰa期小细胞肺癌（SCLC）的预后报道较少。我们回顾性研究了年龄≥60岁的T1N0M0（≤3 cm）SCLC患者，旨在比较分析肺叶切除术和肺叶下切除术治疗Ⅰa期SCLC患者的预后。
从“监测、流行病学和最终结果数据库”（SEER）中选取1992年至2010年间经病理诊断为Ⅰa期SCLC的患者。使用Kaplan-Meier（对数秩检验）和Cox模型多变量分析比较结局数据。
我们共纳入515例患者。肺叶切除术组（n = 110）、肺叶下切除术组（n = 57）和非手术组（n = 348）的中位总生存期（OS）分别为45个月、23个月和16个月。三组相应的5年总生存率分别为44%、30%和14%。有无淋巴结检查/清扫的患者预后无显著差异（P = 0.107），接受肺叶切除术加放化疗患者的5年总生存率为50%。Cox多变量分析显示，手术治疗，包括肺叶切除术和肺叶下切除术，是早期SCLC患者预后的独立相关因素之一，与肺叶下切除术相比，接受肺叶切除术的患者总生存期更好（肺叶切除术与肺叶下切除术相比，HR = 0.645；95%CI：0.433 - 0.961，P = 0.031）。
对于年龄≥60岁的T1N0M0（≤3 cm）SCLC患者，我们建议行解剖性肺叶切除术联合辅助放化疗。
