术后放疗在T1-2N0M0期SCLC治疗中的意义

目的 探讨术后放疗对早期SCLC预后影响。方法 回顾分析我院1997—2010年临床分期为T_1-2N₀M₀期且行根治性切除术的71例SCLC患者临床资料,31例术后放疗,55例术前或术后化疗。Kaplan-Meier法计算LR率、远处转移率及生存率并Logrank法检验及单因素预后分析,Cox模型多因素预后分析。结果 5年样本数32例,5年OS率及LR率分别为52%和22%,术后是否放疗对生存无影响(P=0.524)。对于术后N (-)患者行放疗与未行放疗者中位OS分别为47.3个月与96.8个月(P=0.561),5年LR率分别为39%与23%(P=0.934)。对于术后N (+)患者行放疗者中位生存明显高于未行放疗者(66.7、34.6个月,P=0.016),行放疗者5年LR率亦明显低于未行放疗者(5%、75%,P=0.004)。全组患者远处转移率为30%,术后放疗与否对患者远处转移率无影响(P=0.576)。结论 术后放疗明显降低了术后N (+) SCLC患者LR率并提高了生存,而对N (-)患者反而有降低生存趋势,建议术后N (+)的SCLC患者行术后放疗。

Significance of postoperative radiotherapy in treatment of stage T1-2N0M0 small-cell lung cancer

Objective To investigate the impact of postoperative radiotherapy (PORT) on the prognosis of early-stage small-cell lung cancer (SCLC). Methods The clinical data of 71 patients who were clinically diagnosed with stage T_1-2N₀M₀ SCLC and underwent radical resection surgery in our hospital from 1997 to 2010 were retrospectively analyzed. Thirty-one patients received PORT, and fifty-five patients received preoperative or postoperative chemotherapy. The locoregional recurrence (LRR), distant metastasis, and overall survival (OS) rates were calculated using the Kaplan-Meier method. The log-rank test was used for survival difference analysis and univariate prognostic analysis. The multivariate prognostic analysis was made by the Cox regression model. Results The 5-year sample size was 32. The 5-year OS and LRR rates were 52% and 22%, respectively. PORT had no significant impact on OS rate (P=0.524). There were no significant differences in median OS and 5-year LRR rates between node-negative patients treated with and without PORT (47.3 vs. 96.8 months, P=0.561;39% vs. 23%, P=0.934). In the node-positive patients, patients treated with PORT had a significantly higher median OS rate and a significantly lower 5-year LRR rate than those treated without PORT (66.7 vs. 34.6 months, P=0.016;5% vs. 75%, P=0.004). The distant metastasis rate was 30% in all patients, and PORT had no significant impact on the distant metastasis rate (P=0.576). Conclusions PORT significantly reduces LRR rate and improves OS rate in node-positive patients with SCLC. However, it slightly reduces OS rate in node-negative patients. Therefore, PORT is recommended for node-positive patients with SCLC.