不同治疗方式对Ⅰ-Ⅲa期小细胞肺癌患者预后的影响:一项基于人群的研究。
Different treatment modalities on the prognosis of patients with stage I-IIIa small cell lung cancer: a population based study.
作者信息
Chen Fangjun, Wang Zihan, Gu Xing, Ni Yihong, Qiang Guangliang
机构信息
Department of Thoracic Surgery, China-Japan Friendship Institute of Clinical Medicine, Beijing, China.
College of Foreign Languages, Chongqing Medical University, Chongqing, China.
出版信息
J Thorac Dis. 2024 May 31;16(5):2822-2834. doi: 10.21037/jtd-23-1899. Epub 2024 May 27.
BACKGROUND
Several studies have shown that surgery may improve prognosis in patients with limited-stage small cell lung cancer (LS-SCLC). This study aimed to compare the effects of different treatment modalities on lung cancer specific survival (LCSS) and overall survival (OS) in LS-SCLC patients.
METHODS
The Surveillance, Epidemiology and End Results (SEER) database was used to identify patients diagnosed with LS-SCLC. Kaplan-Meier analysis was used to determine the effect of each factor on LCSS and OS. Multivariate analysis was used to analyze the relationship between patient characteristics and survival of different treatment modalities.
RESULTS
After a series of screening steps, this study ultimately analyzed the prognosis of patients with stage I-IIIa SCLC under different treatment modalities. The results showed that lobectomy plus postoperative chemoradiotherapy was significantly better than chemoradiotherapy or lobectomy in treatment (all P<0.05). For stage II and IIIA patients, lobectomy plus postoperative chemotherapy ± radiotherapy had similar efficacy to chemoradiotherapy in improving patients' LCSS and OS (all P>0.05), and lobectomy plus postoperative chemotherapy ± radiotherapy did not significantly improve LCSS or OS compared with lobectomy (all P>0.05).
CONCLUSIONS
For stage II-IIIa SCLC patients, lobectomy might have similar efficacy to chemoradiotherapy in improving LCSS and OS, and there is no need for adjuvant chemotherapy ± radiotherapy after surgery. For stage I SCLC patients, lobectomy plus postoperative chemoradiotherapy might be superior to chemoradiotherapy or lobectomy in improving LCSS and OS; however, the conclusion might be biased. These results suggest that the effect of surgery on SCLC patients may be worthy of further study.
背景
多项研究表明,手术可能改善局限期小细胞肺癌(LS-SCLC)患者的预后。本研究旨在比较不同治疗方式对LS-SCLC患者肺癌特异性生存(LCSS)和总生存(OS)的影响。
方法
利用监测、流行病学和最终结果(SEER)数据库识别诊断为LS-SCLC的患者。采用Kaplan-Meier分析确定各因素对LCSS和OS的影响。采用多因素分析来分析患者特征与不同治疗方式生存情况之间的关系。
结果
经过一系列筛选步骤,本研究最终分析了I-IIIa期SCLC患者在不同治疗方式下的预后。结果显示,肺叶切除术加术后放化疗在治疗效果上显著优于单纯放化疗或肺叶切除术(均P<0.05)。对于II期和IIIA期患者,肺叶切除术加术后化疗±放疗在改善患者的LCSS和OS方面与放化疗疗效相似(均P>0.05),且与单纯肺叶切除术相比,肺叶切除术加术后化疗±放疗并未显著改善LCSS或OS(均P>0.05)。
结论
对于II-IIIa期SCLC患者,肺叶切除术在改善LCSS和OS方面可能与放化疗疗效相似,术后无需辅助化疗±放疗。对于I期SCLC患者,肺叶切除术加术后放化疗在改善LCSS和OS方面可能优于单纯放化疗或肺叶切除术;然而,该结论可能存在偏差。这些结果表明,手术对SCLC患者的影响可能值得进一步研究。