Johnson B E, Ihde D C, Matthews M J, Bunn P A, Zabell A, Makuch R W, Johnston-Early A, Cohen M H, Glatstein E, Minna J D
Am J Med. 1986 Jun;80(6):1103-10. doi: 10.1016/0002-9343(86)90672-8.
Among 360 patients with small cell lung cancer treated in National Cancer Institute therapeutic trials from 1973 to 1982, 40 were two-year cancer-free survivors. Of these 40 patients, six had later development of non-small-cell lung cancer at 3.5 to 8.0 years (median 5.1) after the diagnosis of small cell lung cancer. Three had the second malignant tumor in the contralateral lung, one in a different lobe, and two in the same lobe as the initial small cell lung cancer. Ten patients had relapses of small cell lung cancer at 2.1 to 6.2 years (median 3.2) from diagnosis. Three recurrences were in the same site or lobe as the initial lesion, four in the same lobe and in sites outside the thorax, and three solely in sites outside the thorax. It is concluded that these non-small-cell lung cancers usually represent second primary lung tumors and that most late small cell lung cancers represent relapses occurring up to 6.2 years from diagnosis. In this study, the risk of development of non-small-cell lung cancer after two years of disease-free survival following small cell lung cancer is 4.4 percent per person-year, approximately 10 times higher than the rate of 0.5 percent previously determined in screening studies of men at high risk for lung cancer. Non-small-cell lung cancer represents more than a third of lung cancer deaths in patients with small cell lung cancer surviving beyond two years from diagnosis and more than half of lung cancer deaths beyond three years. It is recommended that all patients treated for small cell lung cancer discontinue smoking.
在1973年至1982年美国国立癌症研究所治疗试验中接受治疗的360例小细胞肺癌患者中，有40例存活两年且无癌症复发。在这40例患者中，6例在小细胞肺癌诊断后3.5至8.0年（中位时间5.1年）出现了非小细胞肺癌。其中3例对侧肺出现第二原发性恶性肿瘤，1例在不同肺叶，2例在与最初小细胞肺癌相同的肺叶。10例患者在诊断后2.1至6.2年（中位时间3.2年）出现小细胞肺癌复发。3例复发发生在与最初病变相同的部位或肺叶，4例在同一肺叶且在胸部以外部位，3例仅在胸部以外部位。得出的结论是，这些非小细胞肺癌通常代表第二原发性肺肿瘤，并且大多数晚期小细胞肺癌代表诊断后长达6.2年出现的复发。在本研究中，小细胞肺癌无病生存两年后发生非小细胞肺癌的风险为每人每年4.4%，约为先前在肺癌高危男性筛查研究中确定的0.5%发生率的10倍。非小细胞肺癌占诊断后存活超过两年的小细胞肺癌患者肺癌死亡人数的三分之一以上，占存活超过三年患者肺癌死亡人数的一半以上。建议所有接受小细胞肺癌治疗的患者戒烟。
