Chen Xiaolu, Zhu Jia-Li, Wang Huaying, Yu Wanjun, Xu Tao
Department of Respiratory and Critical Care, The Affiliated People's Hospital of Ningbo University, Ningbo, China.
School of Medicine, Tongji University, Shanghai, China.
Front Surg. 2022 Feb 11;9:735102. doi: 10.3389/fsurg.2022.735102. eCollection 2022.
The purpose of this study was to observe the significance of surgery and its approach in stage I-IIA (according to 8th American Joint Committee on Cancer Staging Manual) small-cell lung cancer (SCLC) using the Surveillance, Epidemiology, and End Results (SEER) database.
A total of 1,421 patients from ages 31 to 93 years who were diagnosed with stage I-IIA SCLC in the SEER database from 2010 to 2015 were analyzed. The 1:1 propensity score matching analysis was used to minimize the effect of selection bias, and 355 pairs of patients' data was performed subsequent statistical analysis. K-M analysis and a Cox proportional hazards model were used to observe the role of surgery and other clinical features in the patients' prognoses on cancer-specific survival (CSS).
Overall, within the whole cohort, the 3- and 5-year CSS rates were 41.0 and 34.0%, respectively. In a Cox regression that adjusted for other clinical features, patients were more likely to benefit from the surgery [hazard ratio (HR) 0.292, 95% confidence interval (CI) 0.237-0.361, < 0.001]. Unadjusted 5-year cancer-specific survival among those with surgery was 55.0%, compared with 23.0% among those without surgery. In the propensity scored-matched dataset, however, 5-year CSS among those with surgery was 54.0%, compared with 17.0% among those without surgery (HR 0.380, 95%CI 0.315-0.457, < 0.001). In patients who received surgery, cases with lobectomy had a better 5-year CSS than those without lobectomy (65.0 vs. 39.0%). The lobectomy might be a protective factor for patients who underwent resection in CSS (HR 0.433, 95%CI 0.310-0.604, < 0.001).
We suggested that the surgery and lobectomy were the independent prognostic as well as the protective factors in stage I-IIA SCLC patients. We recommended that patients with no surgical contraindications receive surgery, preferably, lobectomy.
本研究旨在利用监测、流行病学和最终结果（SEER）数据库，观察手术及其方式在Ⅰ-ⅡA期（根据美国癌症联合委员会第8版癌症分期手册）小细胞肺癌（SCLC）中的意义。
分析了2010年至2015年SEER数据库中1421例年龄在31至93岁之间、诊断为Ⅰ-ⅡA期SCLC的患者。采用1:1倾向评分匹配分析以尽量减少选择偏倚的影响，并对355对患者的数据进行后续统计分析。采用K-M分析和Cox比例风险模型观察手术及其他临床特征对患者癌症特异性生存（CSS）预后的作用。
总体而言，在整个队列中，3年和5年CSS率分别为41.0%和34.0%。在调整了其他临床特征的Cox回归分析中，患者更可能从手术中获益[风险比（HR）0.292，95%置信区间（CI）0.237-0.361，P<0.001]。未调整的情况下，接受手术患者的5年癌症特异性生存率为55.0%，未接受手术患者为23.0%。然而，在倾向评分匹配的数据集中，接受手术患者的5年CSS为54.0%，未接受手术患者为17.0%（HR 0.380，95%CI 0.315-0.457，P<0.001）。在接受手术的患者中，肺叶切除病例的5年CSS优于未进行肺叶切除者（65.0%对39.0%）。肺叶切除可能是接受切除患者CSS的保护因素（HR 0.433，95%CI 0.310-0.6X4，P<0.001）。
我们认为手术和肺叶切除是Ⅰ-ⅡA期SCLC患者的独立预后因素及保护因素。我们建议无手术禁忌证的患者接受手术，最好是肺叶切除。
