Lei Yuqiong, Feng Hui, Qiang Huiping, Shang Zhanxian, Chang Qing, Qian Jialin, Zhang Yanwei, Zhong Runbo, Fan Xiaohong, Chu Tianqing
Department of Respiratory Medicine, Shanghai Chest Hospital, Jiaotong University, Shanghai, 200030 PR China.
Department of Emergency, Shanghai Chest Hospital, Jiaotong University, Shanghai, 200030 PR China.
Lung Cancer. 2020 Aug;146:244-251. doi: 10.1016/j.lungcan.2020.06.021. Epub 2020 Jun 17.
Small cell lung cancer (SCLC) is the most malignant lung cancer. Some of them are mixed with non-small cell lung cancer(NSCLC, Non SCLC),which are called combined small cell lung cancer (C-SCLC).Due to the difficulty of pathological diagnosis and the complexity of treatment, studies of C-SCLC have just been rising in recent years. This study is to evaluate the clinical and pathologic characteristics of C-SCLC.
Stage Ⅰ-Ⅲa C-SCLC patients who received radical R0 surgery between 2009-2018 in Shanghai Chest Hospital were enrolled. Clinical characteristics and prognosis were analyzed.
Totally 181 patients were included, most of them were small cell combined with large cell neuroendocrine components(SCLC/LCNEC,58.0 %,N = 105),then with adenocarcinoma(SCLC/ADC:13.8 %,N = 25),and finally with squamous cell carcinoma(SCLC/SCC:13.3 %,N = 24).Median DFS and OS of C-SCLC patients underwent radical surgery were 32.5 and 49.7 months.1,3 and 5 years DFS rates of the entire cohort were 68.5 %,32.6 % and 16.0 %,respectively. Patients with SCLC/LCNEC had longer DFS (44.1 m vs. 20.4 m, p = 0.040) and longer OS trend (62.1 m vs. 33.2 m, p = 0.122).Groups of whether tumor invaded the pleura(p = 0.028 and p = 0.050),lymph node stage(p = 0.029 and p = 0.010) and the courses of adjuvant chemotherapy(p = 0.011 and p = 0.001) had statistical differences on DFS and OS.
SCLC/LCNEC was the most common type of C-SCLC. Patients' DFS and OS were also longer than other combined types. Adjuvant chemotherapy for SCLC is still the main treatment for surgical C-SCLC. Further studies are needed to clarify the clinical characteristics and prognosis of C-SCLC.
小细胞肺癌（SCLC）是最具侵袭性的肺癌。其中一些与非小细胞肺癌（NSCLC，非小细胞肺癌）混合，称为复合型小细胞肺癌（C-SCLC）。由于病理诊断困难和治疗复杂性，近年来C-SCLC的研究才刚刚兴起。本研究旨在评估C-SCLC的临床和病理特征。
纳入2009年至2018年在上海胸科医院接受根治性R0手术的Ⅰ-Ⅲa期C-SCLC患者。分析其临床特征和预后。
共纳入181例患者，其中大多数为小细胞合并大细胞神经内分泌成分（SCLC/LCNEC，58.0%，N = 105），其次为腺癌（SCLC/ADC：13.8%，N = 25），最后为鳞癌（SCLC/SCC：13.3%，N = 24）。接受根治性手术的C-SCLC患者的中位无病生存期（DFS）和总生存期（OS）分别为32.5个月和49.7个月。整个队列的1年、3年和5年DFS率分别为68.5%、32.6%和16.0%。SCLC/LCNEC患者的DFS更长（44.1个月对20.4个月，p = 0.040），OS有延长趋势（62.1个月对33.2个月，p = 0.122）。肿瘤是否侵犯胸膜（p = 0.028和p = 0.050）、淋巴结分期（p = 0.029和p = 0.010）以及辅助化疗疗程（p = 0.011和p = 0.001）在DFS和OS方面存在统计学差异。
SCLC/LCNEC是C-SCLC最常见的类型。患者的DFS和OS也比其他合并类型更长。SCLC的辅助化疗仍然是手术治疗C-SCLC的主要方法。需要进一步研究以阐明C-SCLC的临床特征和预后。
