手术治疗局限期小细胞肺癌45例临床分析
The Treatment Outcomes of Surgery for Limited Stage Small Cell Lung Cancer: An Analysis of 45 Cases
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摘要: 目的: 局限期小细胞肺癌的标准治疗是放化综合治疗,本研究目的为评估手术治疗局限期小细胞肺癌的疗效并分析其预后因素。 方法: 回顾性分析江苏省肿瘤医院1991年10月至2006年10月手术治疗的局限期小细胞肺癌45例的临床资料,所有病例均经病理证实,生存率计算采用Kaplan-meier法,组间比较采用Log rank法。 结果: 按照2002年国际肺癌分期标准,全组术后病理分期为ⅠA1例,ⅠB5例,ⅡA1例,ⅡB9例,ⅢA20例,ⅢB8例,1例在术前诱导化疗后达CR无法分期。全肺切除术8例(含肺移植术1例),肺叶切除术37例。9例术后病理切缘阳性,1例淋巴结无法摘除,根治性手术率78%。单独手术10例,综合治疗35例。全组除2例围手术期死亡外,无瘤生存15例,局部区域复发(残端、肺门、纵隔及锁骨上)共7例,远处转移16例,复发加转移5例,局部区域复发中残端复发是最常见部位,共5例,远处转移中最常见首发部位是脑,共8例。全组1、3、5年生存率分别为74%,37%,30%,中位生存期为29个月。未能鉴别出有统计学意义的预后因素,但疗前血红蛋白水平、有无辅助放化疗及纵隔淋巴结转移与否有影响预后的趋势,其P值分别为0.1085、0.1339和0.1713。 结论: 建立在综合治疗基础上的手术治疗对于小细胞肺癌疗效良好,应进一步评估手术治疗在局限期小细胞肺癌中的地位。Abstract: Objective : Chemoradiation remains the standard treatment for limited stage small cell lung cancer(LD-SCLC). The aim of the study was to evaluate the outcome of patients with LD-SCLC who underwentsurgery. Methods : Data from 45 patients with LD-SCLC treated with surgery between October 1991 and Octo-ber 2006 in our hospital were retrospectively analyzed. Kaplan-Meier estimation was used for survival analy-sis. Results : The median overall survival was 29 months for the whole group; and the 1-, 3- and 5- year sur-vival rates were 74%, 37% and 30%, respectively. No prognostic factors were identified in this study. A highlevel of pre-operative hemoglobin, adjuvant chemoradiation and metastasis to mediastinal lymph nodesseemed to affect prognosis, but no statistical significance was found (P=0.1085, 0.1339 and 0.1713, respec-tively). Conclusion : Based on integrated therapy, surgery can achieve a good outcome for patients withLD-SCLC. Further evaluation is warranted.
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