手术联合化疗治疗ⅢA期小细胞肺癌患者的疗效评估：一项回顾性分析
Efficacy evaluation of surgery combined with chemotherapy for stage IIIA small cell lung cancer patients: a retrospective analysis.
作者信息
Bian Dongliang, Jiang Siming, Xiong Yicheng, Qi Mengfan, Wu Jiawei, Addeo Alfredo, Yamauchi Yoshikane, Manapov Farkhad, Dempke Wolfram C M, Vannucci Jacopo, Di Federico Alessandro, Xu Xiaoxiong, Chen Linsong
机构信息
Department of Thoracic Surgery, Shanghai Pulmonary Hospital, Tongji University School of Medicine, Shanghai, China.
Department of Thoracic Surgery, Tongji University Affiliated Shanghai Pulmonary Hospital, Shanghai, China.
出版信息
Transl Lung Cancer Res. 2022 Aug;11(8):1631-1642. doi: 10.21037/tlcr-22-545.
BACKGROUND
The efficacy of surgery in combination of chemotherapy for stage IIIA small cell lung cancer (IIIA-SCLC) is controversial. The aim of the present study was to analyze the efficacy of surgery combined with chemotherapy, especially in the setting of neoadjuvant chemotherapy (NAC) followed by surgery for IIIA-SCLC.
METHODS
Between 2004 and 2015, we reviewed 2,199 chemotherapy-treated stage IIIA (N1/2) SCLC cases in the Surveillance, Epidemiology, and End Results (SEER) database, and 32 NAC + intentional radical resection-treated, centrally-located IIIA-SCLC cases at Shanghai Pulmonary Hospital (SPH). Outcomes were compared between surgically and non-surgically treated patients from the SEER database after propensity score matching (PSM), and comparing lobectomy/bi-lobectomy and pneumonectomy patients from SPH. Prognostic factors were evaluated by Kaplan-Meier method and the Cox proportional hazards regression model.
RESULTS
There was significantly higher overall survival (OS) in surgically treated IIIA-SCLC patients (OS, 44.8 21.2 months, P=0.048), and similar efficacy was observed between sub-lobectomy and lobectomy/bi-lobectomy patients (OS: 55.6 30.3 months, P=0.167) in SEER database. At SPH, significantly higher OS was associated with T1 stage (before NAC: T1 T2-4, 48.7 32.2 months, P=0.025; after NAC: T1 T2-4, 42.7 21.3 months, P=0.048). Female sex [hazard ratio (HR): 0.078, P=0.009], T1 stage (HR: 13.048, P=0.026), and pneumonectomy (HR: 0.095, P=0.009) were independent prognostic factors for IIIA-SCLC patients who received NAC + intentional radical resection.
CONCLUSIONS
For stage IIIA SCLC patients, complete resection combined with chemotherapy might improve the prognosis than patients without surgery. Post-NAC lobectomy was not found to be superior to sub-lobectomy, while pneumonectomy was considered suitable for central-type IIIA-SCLC patients after NAC treatment.
背景
手术联合化疗治疗IIIA期小细胞肺癌（IIIA - SCLC）的疗效存在争议。本研究的目的是分析手术联合化疗的疗效，尤其是新辅助化疗（NAC）后手术治疗IIIA - SCLC的疗效。
方法
2004年至2015年期间，我们回顾了监测、流行病学和最终结果（SEER）数据库中2199例接受化疗的IIIA期（N1/2）SCLC病例，以及上海肺科医院（SPH）32例接受NAC + 意向性根治性切除治疗的中心型IIIA - SCLC病例。在倾向得分匹配（PSM）后，比较SEER数据库中手术和非手术治疗患者的结局，并比较SPH的肺叶切除/双肺叶切除和全肺切除患者。通过Kaplan - Meier法和Cox比例风险回归模型评估预后因素。
结果
在SEER数据库中，手术治疗的IIIA - SCLC患者总生存期（OS）显著更高（OS，44.8±21.2个月，P = 0.048），亚肺叶切除和肺叶切除/双肺叶切除患者的疗效相似（OS：55.6±30.3个月，P = 0.167）。在SPH，OS显著更高与T1期相关（NAC前：T1对T2 - 4，48.7±32.2个月，P = 0.025；NAC后：T1对T2 - 4，42.7±21.3个月，P = 0.048）。女性[风险比（HR）：0.078，P = 0.009]、T1期（HR：13.048，P = 0.026）和全肺切除（HR：0.095，P = 0.009）是接受NAC + 意向性根治性切除的IIIA - SCLC患者的独立预后因素。
结论
对于IIIA期SCLC患者，与未手术患者相比，完整切除联合化疗可能改善预后。未发现NAC后肺叶切除优于亚肺叶切除，而全肺切除被认为适用于NAC治疗后的中心型IIIA - SCLC患者。
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