Liu Jiaping, Cao Yu, Shao Tianyu, Wang Yuguan
The First School of Clinical Medicine, Zhejiang Chinese Medical University, Hangzhou, People's Republic of China.
The First Affiliated Hospital of Zhejiang Chinese Medical University (Zhejiang Province Hospital of Tradition Chinese Medicine), Hangzhou, People's Republic of China.
Heliyon. 2024 Jun 19;10(12):e32907. doi: 10.1016/j.heliyon.2024.e32907. eCollection 2024 Jun 30.
Combined small cell lung cancer (C-SCLC) is a rare type of small cell lung cancer (SCLC), and it is controversial whether to choose the same treatment regimen as SCLC due to its multiple histologic components.
Records of patients with small cell lung cancer diagnosed between 2010 and 2020 were extracted using the SEER database. The OS of patients with different histological types under the same staging and treatment regimen was analyzed. It was found that early-stage (stage IA-IIA) surgical treatment, systemic chemotherapy alone, and chemoradiotherapy were more efficacious than C-SCLC and P-SCLC in patients with limited-stage (P = 0.054, P = 0.001, P = 0.019). In patients with extensive staging, the OS of patients with systemic chemotherapy regimens differed (P = 0.045) and was better in C-SCLC than in P-SCLC. We further explored the treatment strategy for patients with C-SCLC, which was shown by a COX regression model based on prognostic factors screened by Random Forest and LASSO regression models. Surgery, radiotherapy, and chemotherapy would be beneficial for survival. In a subgroup analysis based on stage and treatment regimen, it was shown that patients with early staging (stage IA-IIA) had a better prognosis with surgery (P < 0.001); in patients with extensive staging, chemoradiotherapy was favorable to the patient's prognosis (P = 0.022).
Both limited-stage and extensive-stage C-SCLC patients are more sensitive to chemotherapy than P-SCLC patients. Patients with C-SCLC who have access to surgery should undergo surgery as early as possible, while chemoradiotherapy is recommended for patients with extensive staging. Patient age, gender, tumor size, surgery, chemotherapy, radiotherapy, and metastasis may individually affect patient prognosis.
小细胞肺癌合并其他成分（C-SCLC）是小细胞肺癌（SCLC）的一种罕见类型，由于其具有多种组织学成分，对于是否选择与SCLC相同的治疗方案存在争议。
利用监测、流行病学与最终结果（SEER）数据库提取2010年至2020年间诊断为小细胞肺癌患者的记录。分析了相同分期和治疗方案下不同组织学类型患者的总生存期（OS）。结果发现，早期（IA-IIA期）手术治疗、单纯全身化疗以及放化疗，对于局限期患者而言，疗效优于C-SCLC和纯小细胞肺癌（P-SCLC）（P = 0.054，P = 0.001，P = 0.019）。在广泛期患者中，全身化疗方案的患者总生存期存在差异（P = 0.045），C-SCLC患者的总生存期优于P-SCLC患者。我们进一步探索了C-SCLC患者的治疗策略，通过基于随机森林和套索回归模型筛选出的预后因素的COX回归模型表明，手术、放疗和化疗对生存有益。在基于分期和治疗方案的亚组分析中，结果显示早期（IA-IIA期）患者手术预后较好（P < 0.001）；在广泛期患者中，放化疗有利于患者预后（P = 0.022）。
局限期和广泛期C-SCLC患者均比P-SCLC患者对化疗更敏感。有手术机会的C-SCLC患者应尽早接受手术，而广泛期患者建议进行放化疗。患者年龄、性别、肿瘤大小、手术、化疗、放疗和转移可能分别影响患者预后。
