混合型小细胞肺癌临床特点及放疗价值  

Clinical features and role of radiotherapy in combined small cell lung cancer

作　　者：门玉[1] 惠周光[1] 翟医蕊[1] 王小震[1] 梁军[1] 吕纪马[1] 周宗玫[1] 冯勤付[1] 陈东福[1] 张红星[1] 肖泽芬[1] 殷蔚伯[1] 王绿化[1] 

机构地区：[1]北京协和医学院中国医学科学院肿瘤医院肿瘤研究所放疗科,100021

出　　处：《中华放射肿瘤学杂志》2013年第5期369-373,共5页Chinese Journal of Radiation Oncology

基　　金：首都卫生发展科研专项基金（2011-4002-05）;北京希望马拉松专项基金（LC2008A15）

摘　　要：目的分析混合型小细胞肺癌临床特征及预后因素，并明确放疗价值。方法回顾分析2005--2011年收治经组织学证实的44例混合型小细胞肺癌病例。采用Kaplan—Me＆r法行生存分析，Logrank法单因素预后分析。结果随访率100％，随访时间满3、5年者分别为14、9例。1、3、5年总生存率分别为69％、47％、33％，无进展生存率分别为53％、44％、32％。单因素分析显示术前卡氏评分〈80（P=0．006）、混合非鳞癌成分（P=0．006）、肿瘤直径〉3cm（P=0．049）、切缘阳性（P=0．001）为影响预后因素。放疗显著提高局部晚期（ⅢA、ⅢB）（P=0．032）、淋巴结阳性（P=0．006）或术后淋巴结阳性〉4个（P=0．025）患者的总生存，有提高T3～T4期患者生存趋势（P=0．179）。结论混合型小细胞肺癌病变相对局限，以综合治疗为主；卡氏评分〈80、混合非鳞癌成分、肿瘤直径〉3cm及术后切缘阳性是预后不良因素；放疗能提高局部晚期、淋巴结阳性或术后淋巴结阳性〉4个患者的总生存。Objective To analyze the clinical features, prognostic factors, and role of radiotherapy in combined small cell lung cancer （C-SCLC）. Methods A retrospective analysis was performed in 44 patients who were histologically diagnosed with C-SCLC from January 2005 to December 2011. The Kaplan- Meier method was used to estimate survival, and the log-rank test was used for univariate prognostic analysis. Results The follow-up was 100%. Fourteen patients were followed up for at least 3 years, and 9 patients for at least 5 years. The 1-, 3-, and 5-year overall survival （ OS ） rates were 69% , 47% , and 33% , respectively, and the 1-, 3-, and 5-year progression-free survival rates were 53%, 44%, and 32%, respectively. The univariate analysis showed that Kamofsky performance scale （KPS） score of 〈 80 （P = 0. 006）, presence of non-squamous cell carcinoma （ P = 0. 006 ）, tumor diameter of 〉 3 cm （ P = 0. 049 ）, and positive surgical margin （P = 0. 001 ） were associated with poorer OS. Radiotherapy significantly improved the OS in patients with stage m A/ Ill B disease （ P = 0. 032） , positive lymph nodes （ P = 0. 006 ）, or over 4 positive lymph nodes after surgery （P = 0. 025 ）, and it nonsignificantly improved the OS in patients with T3-T4 disease （P= 0. 179 ）. Conclusions C-SCLC is mostly in limited stage, and multimodality therapy is recommended. KPS score of 〈 80, presence of non-squamous cell carcinoma, tumor diameter of 〉 3 cm, and positive surgical margin are poor prognostic factors. Radiotherapy can improve the OS in patients with stage IIA/III B disease, positive lymph nodes, or over 4 positive lymph nodes after surgery.

关 键 词：癌 混合型小细胞肺 放射疗法 预后 

分 类 号：R734.2[医药卫生—肿瘤]