Surgery for combined type small cell lung carcinoma

BACKGROUND—Combined type small cell lung cancer(SCLC) has been reported to occur in, at most, 1% of all cases ofSCLC. These tumours consist of SCLC with a component of squamous cellcarcinoma and/or adenocarcinoma. The survival of patients with combinedand pure SCLC after surgical resection was assessed.
METHODS—From 1977 to 1994 2115 patients withbronchogenic carcinoma underwent pulmonary resection. From this group26 patients (1.2%) were diagnosed as having combined SCLC and 74 patients (3.5%) as having pure SCLC.
RESULTS—From the 26 patients with combined SCLC(mean age 66.4 years) three were classified as pT1N0M0, eight aspT2N0M0, four as postoperative stage II, and 11 as postoperative stageIII. Histological examination showed a component of squamous cellcarcinoma in 21patients. There were 18 (69%) lobectomies, seven(27%) pneumonectomies, and one (4%) segmentectomy. In all patientssurgery was thought to be curative. Overall hospital mortality was 4%(n = 1). Cumulative five year survival was 31% for all hospitalsurvivors with combined SCLC postoperative stage I, 50% for those withpT1N0M0, and 25% for those with pT2N0M0 disease. No patients withpostoperative stage II and III disease survived for five years. In the74 patients with pure SCLC hospital mortality was 3% (n = 2);cumulative five year survival was 39% in patients with postoperativestage I disease, 46% for those with pT1N0M0 and 35% for those withpT2N0M0. When compared with pure SCLC, no significant differences infive year survival were evident in patients withpostoperative stage I disease.
CONCLUSIONS—Surgical resection in patientswith combined SCLC postoperative stage I yields a cumulative five yearsurvival of 31% while for those with stage II and III disease therewere no survivors at five years. In patients with stage I combined orpure SCLC surgery can offer a long term disease free interval or mayeven be curative.