Kauffmann-Guerrero Diego, Walter Julia, Kovács Julia, Sellmer Laura, Hatz Rudolf A, Behr Jürgen, Schubert-Fritschle Gabriele, Tufman Amanda, Schneider Christian P
Department of Medicine V, University Hospital, LMU Munich, Munich, Germany; Comprehensive Pneumology Center (CPC), Member of the German Center for Lung Research (DZL), University of Munich (LMU), Munich, Germany.
Department of Medicine V, University Hospital, LMU Munich, Munich, Germany.
Clin Lung Cancer. 2022 May;23(3):244-252. doi: 10.1016/j.cllc.2022.01.004. Epub 2022 Feb 4.
Most SCLC patients are diagnosed with extensive disease (ED) and the prognosis in this cohort remains poor. However, some patients are diagnosed with limited (LD) or very limited (VLD, T1-2, N0-1, M0) disease and previous data suggest that surgical resection might improve outcomes in these patients. Most of the existing evidence comes from small case series. For this reason, we investigated clinical features and surgical outcomes in a large cohort of resected SCLC patients.
We used a large pseudomized dataset (n = 32432) provided by the Munich Cancer Registry to analyze all documented SCLC patients (n = 5043) between 2002 and 2015. We correlated patients' characteristics as well as surgery modalities with survival data and describe trends in the role of surgery in SCLC over the time.
We analyzed 5043 SCLC patients. A total of 161 (3.2%) received either oncological (lobectomy, bilobectomy and pneumonectomy) or limited resection (segmentectomy and wedge resection). We found a significant trend suggesting that resections in SCLC patients become less common in all stages of disease, accompanied by an increased proportion of oncological resections. This suggests a more accurate preoperative staging. In VLD resection was significantly associated with longer survival compared to nonsurgical management (log-rank P = .013). Survival was better with oncological resection compared to atypical resection. Administration of adjuvant chemotherapy was associated with better outcome in all resected patients (P = .01).
VLD SCLC patients benefit from oncological resection. We recommend invasive staging in these patients to ensure VLD. Furthermore, adjuvant chemotherapy should be offered to all resected patients.
大多数小细胞肺癌（SCLC）患者被诊断为广泛期疾病（ED），该队列患者的预后仍然很差。然而，一些患者被诊断为局限期（LD）或极局限期（VLD，T1-2，N0-1，M0）疾病，既往数据表明手术切除可能改善这些患者的预后。现有的大多数证据来自小病例系列。因此，我们调查了一大队列接受手术切除的SCLC患者的临床特征和手术结果。
我们使用慕尼黑癌症登记处提供的大型伪随机数据集（n = 32432）来分析2002年至2015年间所有记录在案的SCLC患者（n = 5043）。我们将患者特征以及手术方式与生存数据相关联，并描述了随着时间推移手术在SCLC中作用的趋势。
我们分析了5043例SCLC患者。共有161例（3.2%）接受了肿瘤切除术（肺叶切除术、双肺叶切除术和全肺切除术）或局限性切除术（肺段切除术和楔形切除术）。我们发现一个显著趋势，即SCLC患者的切除术在疾病的所有阶段都变得不那么常见，同时肿瘤切除术的比例增加。这表明术前分期更准确。与非手术治疗相比，VLD切除术与更长的生存期显著相关（对数秩检验P = 0.013）。与非典型切除术相比，肿瘤切除术的生存率更高。辅助化疗在所有接受手术切除的患者中与更好的预后相关（P = 0.01）。
VLD SCLC患者从肿瘤切除术中获益。我们建议对这些患者进行有创分期以确保为VLD。此外，应向所有接受手术切除的患者提供辅助化疗。
