新辅助化疗对局限期小细胞肺癌治疗的价值
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摘要
目的研究新辅助化疗在局限期小细胞肺癌(small cell lung cancer,SCLC)患者中的治疗效果。方法回顾性分析2007年5月至2016年8月中日友好医院胸外科行手术治疗的55例局限期SCLC患者的临床资料,其中男42例、女13例,平均年龄57岁。根据治疗方式不同将患者分为两组,直接手术组与新辅助化疗组。比较两组的生存差异。结果 55例局限期SCLC患者中位生存期27个月,1年、3年、5年总生存率分别为89.1%、45.0%、33.8%。单因素分析:治疗方式(新辅助化疗和直接手术)和临床N分期对预后影响的差异具有统计学意义(P<0.05)。Cox比例风险回归模型进行多因素生存分析:临床N分期是预后的独立影响因素。结论临床Ⅰ和Ⅱ期患者推荐手术治疗,手术后继续多学科治疗;临床Ⅲ期推荐先行新辅助治疗,根据对化疗药物反应决定下一步治疗方案。淋巴结转移对生存期有显著的影响,精确的临床分期对治疗至关重要。
Objective To investigate the significance of neoadjuvant chemotherapy in the treatment of limited-disease small cell lung cancer(LD-SCLC). Methods We retrospectively analyzed the clinical data of 55 LD-SCLC patients who underwent surgery in the Department of Thoracic Surgery, China-Japan Friendship Hospital from May 2007 to August 2016. There were 42 males and 13 females with a mean age of 57 years. All patients underwent clinical staging before treatment. According to the different treatments, the patients were divided into two groups, a preoperative neoadjuvant chemotherapy group and a direct surgery group. The comparison of long-term survival rates was made between the two groups. Results Among the 55 patients, median survival time was 27 months. The 1-, 3-, 5-year survival rate was 89.1%, 45.0%, 33.8% respectively. Treatment methods and clinical N stage were significantly different in prognosis(P<0. 05). The results of Cox proportional hazards regression model showed that clinical N stage was prognostic factor of LD-SCLC patients(P<0. 05). Conclusion Patients with clinical stage Ⅰ and Ⅱ SCLC are better to receive direct surgery. For patients with clinical stage Ⅲ, it is recommended to reach partial response or complete response with neoadjuvant chemotherapy before surgery. The status of lymph node metastasis is closely related to survival, thus identifying the accurate clinical stage is crucial before treatment.
Objective To investigate the significance of neoadjuvant chemotherapy in the treatment of limited-disease small cell lung cancer(LD-SCLC). Methods We retrospectively analyzed the clinical data of 55 LD-SCLC patients who underwent surgery in the Department of Thoracic Surgery, China-Japan Friendship Hospital from May 2007 to August 2016. There were 42 males and 13 females with a mean age of 57 years. All patients underwent clinical staging before treatment. According to the different treatments, the patients were divided into two groups, a preoperative neoadjuvant chemotherapy group and a direct surgery group. The comparison of long-term survival rates was made between the two groups. Results Among the 55 patients, median survival time was 27 months. The 1-, 3-, 5-year survival rate was 89.1%, 45.0%, 33.8% respectively. Treatment methods and clinical N stage were significantly different in prognosis(P<0. 05). The results of Cox proportional hazards regression model showed that clinical N stage was prognostic factor of LD-SCLC patients(P<0. 05). Conclusion Patients with clinical stage Ⅰ and Ⅱ SCLC are better to receive direct surgery. For patients with clinical stage Ⅲ, it is recommended to reach partial response or complete response with neoadjuvant chemotherapy before surgery. The status of lymph node metastasis is closely related to survival, thus identifying the accurate clinical stage is crucial before treatment.
引文
1Chen W, Zheng R, Baade PD, et al. Cancer statistics in China,2015. CA Cancer J Clin, 2016, 66(2):115-132.
2Siegel RL, Miller KD, Jemal A. Cancer statistics, 2017. CA Cancer J Clin, 2017, 67(1):7-30.
3Pesch B, Kendzia B, Gustavsson P, et al. Cigarette smoking and lung cancer--relative risk estimates for the major histological types from a pooled analysis of case-control studies. Int J Cancer, 2012,131(5):1210-1219.
4Schreiber D, Rineer J, Weedon J, et al. Survival outcomes with the use of surgery in limited-stage small cell lung cancer:should its role be re-evaluated. Cancer, 2010, 116(5):1350-1357.
5Combs SE, Hancock JG, Boffa DJ, et al. Bolstering the case for lobectomy in stagesⅠ,Ⅱ, andⅢA small-cell lung cancer using the National Cancer Data Base. J Thorac Oncol, 2015, 10(2):316-323.
6 Fujimori K, Yokoyama A, Kurita Y, et al. A pilot phase 2 study of surgical treatment after induction chemotherapy for resectable stageⅠtoⅢA small cell lung cancer. Chest, 1997, 111(4):1089-1093.
7Hara N, Ohta M, Ichinose Y, et al. Influence of surgical resection before and after chemotherapy on survival in small cell lung cancer. J Surg Oncol, 1991, 47(1):53-61.
8Wada H, Yokomise H, Tanaka F, et al. Surgical treatment of small cell carcinoma of the lung:advantage of preoperative chemotherapy. Lung Cancer, 1995, 13(1):45-56.
9Veronesi G, Scanagatta P, Leo F, et al. Adjuvant surgery after carboplatin and VP16 in resectable small cell lung cancer. J Thorac Oncol, 2007, 2(2):131-134.
10Ohkubo T, Ito K, Sugiura H, et al. Surgical analysis for small cell lung cancer of the lung. Kyobu Geka, 1999, 52(13):1061-1066.
11Lucchi M, Mussi A, Chella A, et al. Surgery in the management of small cell lung cancer. Eur J Cardiothorac Surg, 1997, 12(5):689-693.
12Jin F, Qu B, Fu Z, et al. Prognostic value of metabolic parameters of metastatic lymph nodes on(18)F-FDG PET/CT in patients with limited-stage small-cell lung cancer with lymph node involvement.Clin Lung Cancer, 2018, 19:e101-e108.
13Nakamura H, Kato Y, Kato H. Outcome of surgery for small cell lung cancer--response to induction chemotherapy predicts survival. Thorac Cardiovasc Surg, 2004, 52(4):206-210.
14Friess GG, McCracken JD, Troxell ML, et al. Effect of initial resection of small-cell carcinoma of the lung:a review of Southwest Oncology Group Study 7628. J Clin Oncol, 1985, 3(7):964-968.
15 段勇,白连启,龚昌帆,等.术前化疗对小细胞肺癌远期生存的影响.中华医学杂志, 2009, 89(31):2199-2201.
2Siegel RL, Miller KD, Jemal A. Cancer statistics, 2017. CA Cancer J Clin, 2017, 67(1):7-30.
3Pesch B, Kendzia B, Gustavsson P, et al. Cigarette smoking and lung cancer--relative risk estimates for the major histological types from a pooled analysis of case-control studies. Int J Cancer, 2012,131(5):1210-1219.
4Schreiber D, Rineer J, Weedon J, et al. Survival outcomes with the use of surgery in limited-stage small cell lung cancer:should its role be re-evaluated. Cancer, 2010, 116(5):1350-1357.
5Combs SE, Hancock JG, Boffa DJ, et al. Bolstering the case for lobectomy in stagesⅠ,Ⅱ, andⅢA small-cell lung cancer using the National Cancer Data Base. J Thorac Oncol, 2015, 10(2):316-323.
6 Fujimori K, Yokoyama A, Kurita Y, et al. A pilot phase 2 study of surgical treatment after induction chemotherapy for resectable stageⅠtoⅢA small cell lung cancer. Chest, 1997, 111(4):1089-1093.
7Hara N, Ohta M, Ichinose Y, et al. Influence of surgical resection before and after chemotherapy on survival in small cell lung cancer. J Surg Oncol, 1991, 47(1):53-61.
8Wada H, Yokomise H, Tanaka F, et al. Surgical treatment of small cell carcinoma of the lung:advantage of preoperative chemotherapy. Lung Cancer, 1995, 13(1):45-56.
9Veronesi G, Scanagatta P, Leo F, et al. Adjuvant surgery after carboplatin and VP16 in resectable small cell lung cancer. J Thorac Oncol, 2007, 2(2):131-134.
10Ohkubo T, Ito K, Sugiura H, et al. Surgical analysis for small cell lung cancer of the lung. Kyobu Geka, 1999, 52(13):1061-1066.
11Lucchi M, Mussi A, Chella A, et al. Surgery in the management of small cell lung cancer. Eur J Cardiothorac Surg, 1997, 12(5):689-693.
12Jin F, Qu B, Fu Z, et al. Prognostic value of metabolic parameters of metastatic lymph nodes on(18)F-FDG PET/CT in patients with limited-stage small-cell lung cancer with lymph node involvement.Clin Lung Cancer, 2018, 19:e101-e108.
13Nakamura H, Kato Y, Kato H. Outcome of surgery for small cell lung cancer--response to induction chemotherapy predicts survival. Thorac Cardiovasc Surg, 2004, 52(4):206-210.
14Friess GG, McCracken JD, Troxell ML, et al. Effect of initial resection of small-cell carcinoma of the lung:a review of Southwest Oncology Group Study 7628. J Clin Oncol, 1985, 3(7):964-968.
15 段勇,白连启,龚昌帆,等.术前化疗对小细胞肺癌远期生存的影响.中华医学杂志, 2009, 89(31):2199-2201.