手术切除后联合型和单纯型小细胞肺癌（SCLC）的临床病理特征和预后比较研究。
Comparative study of clinicopathological characteristics and prognosis between combined and pure small cell lung cancer (SCLC) after surgical resection.
机构信息
Department of Medical Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.
Department of Pathology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.
出版信息
Thorac Cancer. 2020 Oct;11(10):2782-2792. doi: 10.1111/1759-7714.13591. Epub 2020 Aug 11.
BACKGROUND
Histologically, SCLC are classified as pure (P-SCLC) and combined subtypes (C-SCLC). Currently, few studies compare the clinicopathological characteristics and explore the treatment strategies applied to them.
METHODS
Between July 2005 and April 2016, the clinical records of 297 postoperative patients with pathologically confirmed SCLC were retrospectively analyzed. Kaplan-Meier method and Cox regression model were separately used for stratified univariate and multivariate survival analysis.
RESULTS
A total of 46 cases (15.5%) of C-SCLCs and 251 cases (85.5%) of pure SCLCs (P-SCLCs) were included in this study. The average age of C-SCLCs was a little higher than that of P-SCLCs (59.65 ± 8.72 vs. 56.56 ± 10.12; P = 0.053). More patients had a history of smoking in C-SCLC (78.3% vs. 63.3%; P = 0.074). The five-year overall survival (OS) rate for P-SCLCs and C-SCLCs was 65.1% and 56.7%, respectively (P = 0.683). For P-SCLC, stage and an intervention of prophylactic cranial irradiation (PCI) were independent factors that affected OS. In C-SCLCs cases, performing sublobectomy was an independent risk factor for poor prognosis.
CONCLUSIONS
We identified no significant difference in clinical characteristics and outcome between C-SCLCs and P-SCLCs. However, the factors affecting the prognosis of the two subtypes were slightly inconsistent. For C-SCLCs, the extent of resection had a greater impact on survival, and lobectomy combined with systemic lymph node dissection should therefore be performed as extensively as possible. In addition, PCI was beneficial in improving the SCLC OS rate.
KEY POINTS
This study demonstrated the prognosis of C-SCLCs did not significantly differ from that of P-SCLCs, but was more susceptible to the extent of resection. Patients with C-SCLC who underwent limited resection had a significantly increased risk of shorter OS. This study highlighted the importance of performing lobectomy for resectable C-SCLC patients. This study also proved the benefit of PCI in improving the OS rate for both P-SCLC and C-SCLC patients.
背景
组织学上，SCLC 分为纯（P-SCLC）和混合型（C-SCLC）亚型。目前，很少有研究比较它们的临床病理特征并探讨适用于它们的治疗策略。
方法
回顾性分析了 2005 年 7 月至 2016 年 4 月间 297 例术后病理证实的 SCLC 患者的临床资料。采用 Kaplan-Meier 法和 Cox 回归模型分别进行分层单因素和多因素生存分析。
结果
本研究共纳入 46 例（15.5%）C-SCLC 和 251 例（85.5%）纯 SCLC（P-SCLC）患者。C-SCLC 的平均年龄略高于 P-SCLC（59.65±8.72 岁比 56.56±10.12 岁；P=0.053）。C-SCLC 患者中更多人有吸烟史（78.3%比 63.3%；P=0.074）。P-SCLC 和 C-SCLC 的 5 年总生存率分别为 65.1%和 56.7%（P=0.683）。对于 P-SCLC，分期和预防性颅脑照射（PCI）的干预是影响 OS 的独立因素。在 C-SCLC 病例中，亚肺叶切除术是预后不良的独立危险因素。
结论
我们发现 C-SCLC 和 P-SCLC 之间在临床特征和结局方面没有显著差异。然而，影响两种亚型预后的因素略有不同。对于 C-SCLC，切除范围对生存的影响更大，因此应尽可能广泛地进行肺叶切除术和系统淋巴结清扫术。此外，PCI 有利于提高 SCLC 的 OS 率。
重点
本研究表明 C-SCLC 的预后与 P-SCLC 无显著差异，但更易受切除范围的影响。接受局限性切除术的 C-SCLC 患者 OS 明显缩短的风险显著增加。本研究强调了对可切除的 C-SCLC 患者行肺叶切除术的重要性。本研究还证明了 PCI 对提高 P-SCLC 和 C-SCLC 患者 OS 率的益处。
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