Szczepek B, Szymańska D, Decker E, Wasowska H, Slupek A, Rowińska-Zakrzewska E
Institute of Tuberculosis and Chest Disease, Warsaw, Poland.
Lung Cancer. 1994 Jul;11(1-2):93-104. doi: 10.1016/0169-5002(94)90286-0.
The aim of this study was to illustrate some difficulties in distinguishing late recurrence of small cell lung cancer (SCLC), from second primary lung cancer. Three-hundred fourteen SCLC patients were observed at the Institute of Tuberculosis and Chest Diseases in Warsaw, during the period 1976-1985. All patients were treated with chemotherapy and 125 were also treated with radiotherapy on the tumour and mediastinum. Nineteen patients (6%) survived 3 years. This group consisted of eight females (9%) and 11 males (5%). In all of them a complete remission was obtained. In six patients from this group no progression of lung cancer was observed. Four of them are still living, 7.9-16.2 years after the start of treatment. Two patients died of heart infarct. In the remaining 13 patients, progression of SCLC or development of new cancer was noted in the course of observation. In seven of them, histological proof of the character of progression was obtained. In four cases non-small cell lung cancer (NSCLC) was diagnosed after 3-11 years of observation. In one of them SCLC metastases in the liver were unexpectedly found in the autopsy, although adenocarcinoma in the lung diagnosed during bronchoscopy was also confirmed in the autopsy. In three cases SCLC was diagnosed. In one case, 2.7 years from the beginning of treatment, only SCLC metastases were found during laparoscopy. SCLC was found in two other cases after a 7-year cancer-free period. In one of those patients, a new lesion was found in the other lung while the second patient developed a new lesion exactly in the place of the former cancer. In six other patients no histological proof of the character of progression was obtained. Two of the six are still living, 8.2 and 15.1 years later. In the first of these two, a new lesion developed very early in the course of treatment in the same place as the primary tumour and it was regarded as the progression of SCLC. In the second patient, who probably had NSCLC the lesion developed in the contralateral lung after 12.5 years of remission and disappeared after radiotherapy. Four patients died of cancer after 3.2-6.4 years of observation. The cumulative risk of a second primary lung cancer after a 3-year survival period oscillated in our SCLC patients between 4% and 6% for every patient/year of observation. It was concluded that prognosis in SCLC patients is still doubtful, nevertheless, some patients made a complete recovery.
本研究的目的是阐明区分小细胞肺癌（SCLC）晚期复发与第二原发性肺癌的一些困难。1976年至1985年期间，在华沙结核病和胸部疾病研究所观察了314例SCLC患者。所有患者均接受化疗，125例患者还接受了肿瘤和纵隔的放射治疗。19例患者（6%）存活了3年。该组包括8名女性（9%）和11名男性（5%）。他们均获得了完全缓解。该组中有6例患者未观察到肺癌进展。其中4例仍在世，治疗开始后7.9至16.2年。2例患者死于心肌梗死。在其余13例患者中，观察过程中发现SCLC进展或出现新癌症。其中7例获得了进展特征的组织学证据。4例在观察3至11年后被诊断为非小细胞肺癌（NSCLC）。其中1例在尸检时意外发现肝脏中有SCLC转移，尽管支气管镜检查期间诊断的肺部腺癌在尸检中也得到了证实。3例被诊断为SCLC。1例在治疗开始2.7年后，腹腔镜检查仅发现SCLC转移。另外2例在7年无癌期后发现SCLC。其中1例患者在另一肺中发现新病变，而另1例患者在原癌部位恰好出现新病变。其他6例患者未获得进展特征的组织学证据。这6例中有2例仍在世，分别在8.2年和15.1年后。在这2例中的第一例中，治疗过程中很早就在与原发肿瘤相同的部位出现了新病变，被视为SCLC进展。在第二例患者中，可能患有NSCLC，在缓解12.5年后对侧肺出现病变，放疗后消失。4例患者在观察3.2至6.4年后死于癌症。在我们的SCLC患者中，3年生存期后第二原发性肺癌的累积风险在每位患者每年的观察中在4%至6%之间波动。结论是SCLC患者的预后仍然不确定，尽管如此，一些患者完全康复。
