新辅助化疗在手术为主综合治疗局限性小细胞肺癌中的意义  

Neoadjuvant chemotherapy＇s value and significance in combining with surgical treatment for limited small cell lung cancer （LD-SCLC）

作　　者：许永杰[1] 郑卉[2] 姜格宁[2] 陈昶[2] 高文[2] 

机构地区：[1]苏州大学医学院 [2]同济大学附属上海市肺科医院胸外科,200030

出　　处：《中华胸心血管外科杂志》2014年第8期473-475,共3页Chinese Journal of Thoracic and Cardiovascular Surgery

摘　　要：目的 评估术前新辅助化疗在手术为主综合治疗局限性小细胞肺癌（LD-SCLC）中的意义.方法 2000年1月至2011年1月,94例肺癌根治手术联合化疗治疗的LD-SCLC患者,分为术前新辅助化疗＋手术＋术后化疗（A组）43例,手术＋术后化疗（B组）51例.结果 整体平均年龄（56.37±10.18）岁.整体5年生存率是27％,Ⅰ～Ⅱ期患者的5年生存率显著高于Ⅲ期患者（34％对20％,P=0.033）.对于Ⅰ～Ⅱ期患者,A组和B组的5年生存率差异不明显（33％对37％,P=0.185）;Ⅲ期患者,A组的5年生存率显著高于B组,有统计学意义（34％对12％,P =0.020）;多因素回归分析表明术前新辅助化疗是影响Ⅲ期LD-SCLC患者预后的重要独立危险因素.结论 术前新辅助化疗可显著提高Ⅲ期LD-SCLC患者术后的预后,是一个合理可行的治疗选择.Objective To analyze and evaluate neoadjuvant chemotherapy＇s value and significance in combining with surgical treatment for limited small cell lung cancer（LD-SCLC）.Methods A total of 94 LD-SCLC patients underwent complete resections combined with chemotherapy between January 2000 and January 2011 in Shanghai Pulmonary Hospital.Among these cases,initial two cycles of neoadjuvant chemotherapies were performed for all pathologically confirmed patients （Group A）,and initial operations followed by adjuvant chemotherapy were administered to patients without pathology （Group B）.The survival rate was analyzed by log-rank test and Kaplan-Meier method.Multivariate analysis of the prognostic factors was performed using Cox＇s regression model.Results Group A included 43 cases and Group B included 51 cases.The mean age was （56.37 ± 10.18） years.According to the 6th edition of Tumor,Node,Metastasis（TNM） classification of lung cancer,54 cases were at stage Ⅰ or Ⅱ,40 cases were at stage Ⅲ.Overall 5-year survival（5-YS） was 27%.The 5-YS for patients with stage Ⅰ-Ⅱ was notably better than that of stage Ⅲ （34% vs 20%,P =0.033）.For patients with stage Ⅲ,the 5-YS of Group A was significantly better than that of Group B（34% vs 12%,P =0.020）,besides median overall survival for Group A and Group B were 46 and 15 months（P =0.009）.Furthermore,the results of multivariate analysis showed that neoadjuvant chemotherapy,surgery and histopathology of SCLC were independent factors that strongly affected survival and prognosis.Conclusion In combined surgical treatment for LD-SCLC,neoadjuvant chemotherapy obviously improved the prognosis of patients with stage Ⅲ.Therefore,it was very important and necessary that pre-surgical neoadjuvant chemotherapy was administered to resectable stage Ⅲ LD-SCLC patients.

关 键 词：局限性小细胞肺癌 术前新辅助化疗 手术 术后化疗 

分 类 号：R734.2[医药卫生—肿瘤]