Department of Thoracic Oncology, West China Hospital, Sichuan University, Chengdu, China.
West China School of Medicine, Sichuan University, Chengdu, China.
World J Surg Oncol. 2020 Feb 3;18(1):27. doi: 10.1186/s12957-020-1807-1.
The NCCN (National Comprehensive Cancer Network) Clinical Practice Guidelines in Oncology (NCCN guidelines) recommend radical resection for T1-2N0M0 patients with limited-stage small cell lung cancer (LS-SCLC). However, only about 5% of patients with small cell cancer (SCLC) were initially diagnosed as T1-2N0M0. The purpose of our study was to analyze and compare the effects of the comprehensive treatment including radical surgery and concurrent chemoradiotherapy on the prognosis of patients with LS-SCLC.
We comprehensively reviewed the medical data of patients with SCLC diagnosed by pathology in our hospital from January 2011 to April 2018. The Ethics Committee of West China Hospital of Sichuan University approved the study. Finally, 50 patients with good follow-up and complete medical data were selected as the surgical group (S group). According to the clinical characteristics of the patients in the S group, 102 LS-SCLC patients who received concurrent chemoradiotherapy in the same period were included in the CCRT group (concurrent chemoradiotherapy group) as the control group. Then according to the orders of the adjuvant treatments, the patients in the S group were divided into the SA group (radical surgery + adjuvant chemotherapy + adjuvant radiotherapy group, 30 cases in total) and the NS group (neoadjuvant chemotherapy + radical surgery + adjuvant chemotherapy ± adjuvant radiotherapy group, 20 cases in total) for subgroup analysis. The SPSS 23.0 software was used for statistical analysis, and the t test was used for group comparison; Kaplan-Meier was used for survival analysis. P < 0.05 demonstrates a statistically significant difference.
The median progress-free survival (PFS) in the S group (73 months) was significantly better than that in the CCRT group (10.5 months, P < 0.0001), and the median overall survival (OS) in the S group (79 months) was also significantly better than that in the CCRT group (23 months, P < 0.0001). Subgroup analysis showed that there was no significant difference between the NS group and the SA group.
For LS-SCLC patients, the comprehensive treatment including radical surgery (radical surgery + adjuvant chemotherapy ± adjuvant radiotherapy/neoadjuvant chemotherapy + radical surgery + adjuvant chemotherapy ± adjuvant radiotherapy)may be superior to concurrent chemoradiotherapy.
NCCN（国家综合癌症网络）临床肿瘤学实践指南（NCCN 指南）建议对局限性小细胞肺癌（LS-SCLC）的 T1-2N0M0 患者进行根治性切除术。然而，只有约 5%的小细胞癌（SCLC）患者最初被诊断为 T1-2N0M0。本研究旨在分析和比较包括根治性手术和同期放化疗在内的综合治疗对 LS-SCLC 患者预后的影响。
我们全面回顾了 2011 年 1 月至 2018 年 4 月我院病理诊断为 SCLC 的患者的医疗数据。四川大学华西医院伦理委员会批准了这项研究。最终，选择了 50 例随访良好且病历资料完整的患者作为手术组（S 组）。根据 S 组患者的临床特征，选择同期接受同期放化疗的 102 例 LS-SCLC 患者作为同期放化疗组（CCRT 组）作为对照组。然后，根据辅助治疗的顺序，S 组患者分为 SA 组（根治性手术+辅助化疗+辅助放疗组，共 30 例）和 NS 组（新辅助化疗+根治性手术+辅助化疗±辅助放疗组，共 20 例）进行亚组分析。采用 SPSS 23.0 软件进行统计分析，组间比较采用 t 检验；采用 Kaplan-Meier 进行生存分析。P＜0.05 表示差异具有统计学意义。
S 组患者的中位无进展生存期（PFS）（73 个月）明显优于 CCRT 组（10.5 个月，P＜0.0001），S 组患者的中位总生存期（OS）（79 个月）也明显优于 CCRT 组（23 个月，P＜0.0001）。亚组分析显示 NS 组与 SA 组之间无显著差异。
对于 LS-SCLC 患者，根治性手术（根治性手术+辅助化疗±辅助放疗/新辅助化疗+根治性手术+辅助化疗±辅助放疗）联合综合治疗可能优于同期放化疗。
