Department of Thoracic and Cardiovascular Surgery, University of Texas MD Anderson Cancer Center, Houston, Tex.
Thoracic Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY.
J Thorac Cardiovasc Surg. 2021 Mar;161(3):760-771.e2. doi: 10.1016/j.jtcvs.2020.10.148. Epub 2020 Nov 27.
Adjuvant chemotherapy, postoperative radiation (PORT), and prophylactic cranial irradiation (PCI) have been individually examined in limited-stage small cell lung cancer (SCLC). There is a paucity of data on the effectiveness of each adjuvant treatment modality when used in combination after surgical resection of SCLC.
Data were collected from 5 cancer centers on all patients with limited-stage SCLC who underwent surgical resection between 1986 and 2019. Univariate and multivariable models were conducted to identify predictors of long-term outcomes, focusing on freedom from recurrence and survival benefit of adjuvant chemotherapy, PORT, and PCI.
A total of 164 patients were analyzed. Multivariable Cox regression analysis did not identify any adjuvant therapies to significantly influence recurrence in this cohort. Specifically, PORT was not associated with a significant influence on locoregional recurrence and PCI was not significantly associated with intracranial outcomes. Adjuvant chemotherapy improved survival in all stage I through III disease (hazard ratio, 0.49; 95% confidence interval, 0.29-0.81; P = .005) and even in pathologically node negative patients (hazard ratio, 0.49; 95% confidence interval, 0.27-0.91; P = .024). Although PCI was found to improve survival in univariate analysis, it was not significant in a multivariable model. PORT was not found to affect survival on either univariate or multivariable analysis.
This is among the largest multi-institutional studies on surgically resected limited-stage SCLC. Our results highlight survival benefit of adjuvant chemotherapy, but did not identify a statistically significant influence from mediastinal PORT or PCI in our cohort. Larger prospective studies are needed to determine the benefit of PORT or PCI in a surgically resected limited-stage SCLC population.
辅助化疗、术后放疗（PORT）和预防性颅脑照射（PCI）已分别在局限期小细胞肺癌（SCLC）中进行了研究。关于 SCLC 手术后联合使用这些辅助治疗方法的有效性的数据很少。
从 5 个癌症中心收集了所有在 1986 年至 2019 年间接受手术切除的局限期 SCLC 患者的数据。进行了单变量和多变量模型分析，以确定与长期结果相关的预测因素，重点是辅助化疗、PORT 和 PCI 的无复发生存率和生存获益。
共分析了 164 例患者。多变量 Cox 回归分析未发现任何辅助治疗方法对该队列的复发有显著影响。具体来说，PORT 对局部复发无显著影响，PCI 对颅内结果无显著影响。辅助化疗改善了所有 I 期至 III 期疾病（风险比，0.49；95%置信区间，0.29-0.81；P=.005）和病理淋巴结阴性患者（风险比，0.49；95%置信区间，0.27-0.91；P=.024）的生存。虽然 PCI 在单变量分析中发现能提高生存率，但在多变量模型中不显著。PORT 在单变量或多变量分析中均未发现对生存率有影响。
这是最大的关于手术切除局限期 SCLC 的多机构研究之一。我们的结果强调了辅助化疗的生存获益，但在我们的队列中没有发现纵隔 PORT 或 PCI 的统计学显著影响。需要更大的前瞻性研究来确定 PORT 或 PCI 在手术切除的局限期 SCLC 人群中的获益。
