Iannuzzi M C, Scoggin C H
Am Rev Respir Dis. 1986 Sep;134(3):593-608. doi: 10.1164/arrd.1986.134.3.593.
Lung cancer is the predominant fatal neoplasm of our time, and SCLC, which accounts for about 25% of all lung cancer, if untreated results in death in about 3 months. Currently employed aggressive combination chemotherapy has allowed a 4- to 5-fold improvement in median survival over untreated patients. Ten to 20% of patients with limited disease can be expected to have a long-term (2-yr) survival. The majority of patients, however, have extensive disease. For these patients the median survival is about 7 months. Less than 2% survive 2 yr. During the last 10 yr, experience in the treatment of thousands of patients has been reported. These trials, using a large variety of drug combinations, doses, and schedules as well as multiple modalities including radiotherapy, surgery, and bone marrow transplantation, demonstrate that a plateau has been reached with our present therapeutic approach. The development of new effective therapeutic strategies as well as prevention of SCLC require a better basic understanding of the cellular pathophysiology of the disease. A consistent chromosomal abnormality has been associated with SCLC. This may provide new insight into predisposition and pathogenesis of SCLC. How this chromosomal abnormality relates to loss of control of cell growth is under intense investigation. Similarly, during the past 3 yr, the identification of growth regulatory oncogenes has greatly improved our understanding of malignancy. The discovery that metastatic cells escape immune surveillance has led to attempts at modulating antigenic expression. The modulation of cellular antigenic expression may facilitate the destruction of tumor cells by host defense mechanisms. The understanding of the genetic basis of drug resistance may lead to approaches that prevent or delay resistance. This century has witnessed the emergence of SCLC as an important fatal neoplasm. It has also been during this time that another, formerly dominant pulmonary condition, tuberculosis, has been controlled. The reduction of tuberculosis was accomplished by a combination of scientific understanding, beginning with the discovery of Koch's bacillus, and public health measures. Perhaps a similar parallel for SCLC as well as other forms of cancer will be written. Basic cellular investigations with the new tools of molecular biology as well as measures to control exposure to predisposing environmental factors such as component of cigarette smoke may one day lead to control of SCLC.
肺癌是当今主要的致命性肿瘤，而小细胞肺癌（SCLC）约占所有肺癌的25%，若不治疗，约3个月内就会导致死亡。目前采用的积极联合化疗已使中位生存期较未治疗患者提高了4至5倍。预计10%至20%的局限性疾病患者可实现长期（2年）生存。然而，大多数患者患有广泛性疾病。对于这些患者，中位生存期约为7个月。不到2%的患者能存活2年。在过去10年里，已有数千例患者的治疗经验报道。这些试验采用了各种各样的药物组合、剂量和方案，以及包括放疗、手术和骨髓移植在内的多种治疗方式，结果表明我们目前的治疗方法已达到一个平台期。开发新的有效治疗策略以及预防小细胞肺癌需要对该疾病的细胞病理生理学有更好的基础认识。一种一致的染色体异常与小细胞肺癌有关。这可能为小细胞肺癌的易感性和发病机制提供新的见解。这种染色体异常与细胞生长失控之间的关系正在深入研究中。同样，在过去3年里，生长调节癌基因的鉴定极大地增进了我们对恶性肿瘤的理解。转移细胞逃避免疫监视这一发现促使人们尝试调节抗原表达。调节细胞抗原表达可能有助于宿主防御机制破坏肿瘤细胞。对耐药性遗传基础的理解可能会带来预防或延缓耐药性的方法。本世纪见证了小细胞肺癌成为一种重要的致命性肿瘤。也正是在这段时间里，另一种曾经占主导地位的肺部疾病——肺结核得到了控制。肺结核的减少是通过从发现结核杆菌开始的科学认识与公共卫生措施相结合实现的。也许有一天会为小细胞肺癌以及其他癌症形式书写类似的篇章。利用分子生物学新工具进行的基础细胞研究以及控制接触如香烟烟雾成分等诱发环境因素的措施，可能有一天会实现对小细胞肺癌的控制。
