Li Shuangyi, Jin Kaiqi, Pan Yingying, Wu Chunxiao, Ren Shengxiang, Jiang Gening, Zhang Peng
Department of Thoracic Surgery, Tongji University Affiliated Shanghai Pulmonary Hospital, Tongji University School of Medicine, Shanghai, China.
Department of Oncology, Tongji University Affiliated Shanghai Pulmonary Hospital, Tongji University School of Medicine, Shanghai, China.
J Thorac Dis. 2021 May;13(5):2738-2745. doi: 10.21037/jtd-20-3047.
The role of surgery in the multidisciplinary treatment of clinical stage IIIA small cell lung cancer is yet to be verified. This study was performed to determine the benefit of surgery in patients with stage IIIA small cell lung cancer.
Patients diagnosed with stage IIIA small cell lung cancer at Shanghai Pulmonary Hospital from 2005 to 2015 were included and divided into two groups: the surgery with neoadjuvant and adjuvant chemotherapy group and the concurrent chemo-radiotherapy group. Overall survival was compared between the two groups. A multivariate Cox regression model was constructed to evaluate factors associated with overall survival.
Of 69 patients with stage IIIA small cell lung cancer during the study period, 40 patients (58%) underwent surgery with neoadjuvant and adjuvant chemotherapy, and 29 patients (42%) underwent concurrent chemo-radiotherapy. Patients in the surgery with neoadjuvant and adjuvant chemotherapy group had a longer overall survival compared with patients in the concurrent chemo-radiotherapy group (median survival: 33.1 16.2 months, respectively; 2-year overall survival: 44.2% 14.9%, respectively; log-rank: P=0.045). A multivariate analysis revealed that surgery with neoadjuvant and adjuvant chemotherapy (hazard ratio: 0.374; 95% confidence interval: 0.173-0.808, P=0.012) was independently associated with overall survival.
Patients with stage IIIA small cell lung cancer treated with surgical resection plus chemotherapy demonstrated longer overall survival compared with those who underwent concurrent chemo-radiotherapy. Surgery may be an option for clinical stage IIIA small cell lung cancer after induction chemotherapy in selected patients.
手术在临床ⅢA期小细胞肺癌多学科治疗中的作用尚待验证。本研究旨在确定手术对ⅢA期小细胞肺癌患者的益处。
纳入2005年至2015年在上海肺科医院诊断为ⅢA期小细胞肺癌的患者，并分为两组：新辅助和辅助化疗联合手术组以及同步放化疗组。比较两组的总生存期。构建多因素Cox回归模型以评估与总生存期相关的因素。
在研究期间的69例ⅢA期小细胞肺癌患者中，40例（58%）接受了新辅助和辅助化疗联合手术，29例（42%）接受了同步放化疗。新辅助和辅助化疗联合手术组患者的总生存期长于同步放化疗组患者（中位生存期：分别为33.1个月和16.2个月；2年总生存率：分别为44.2%和14.9%；对数秩检验：P = 0.045）。多因素分析显示，新辅助和辅助化疗联合手术（风险比：0.374；95%置信区间：0.173 - 0.808，P = 0.012）与总生存期独立相关。
与接受同步放化疗的患者相比，接受手术切除加化疗治疗的ⅢA期小细胞肺癌患者的总生存期更长。对于部分经过诱导化疗的临床ⅢA期小细胞肺癌患者，手术可能是一种选择。
