Role of surgery in a case-control study of patients with clinical stage IIIA small cell lung cancer

BackgroundThe role of surgery in the multidisciplinary treatment of clinical stage IIIA small cell lung cancer is yet to be verified. This study was performed to determine the benefit of surgery in patients with stage IIIA small cell lung cancer.MethodsPatients diagnosed with stage IIIA small cell lung cancer at Shanghai Pulmonary Hospital from 2005 to 2015 were included and divided into two groups: the surgery with neoadjuvant and adjuvant chemotherapy group and the concurrent chemo-radiotherapy group. Overall survival was compared between the two groups. A multivariate Cox regression model was constructed to evaluate factors associated with overall survival.ResultsOf 69 patients with stage IIIA small cell lung cancer during the study period, 40 patients (58%) underwent surgery with neoadjuvant and adjuvant chemotherapy, and 29 patients (42%) underwent concurrent chemo-radiotherapy. Patients in the surgery with neoadjuvant and adjuvant chemotherapy group had a longer overall survival compared with patients in the concurrent chemo-radiotherapy group (median survival: 33.1 vs. 16.2 months, respectively; 2-year overall survival: 44.2% vs. 14.9%, respectively; log-rank: P=0.045). A multivariate analysis revealed that surgery with neoadjuvant and adjuvant chemotherapy (hazard ratio: 0.374; 95% confidence interval: 0.173–0.808, P=0.012) was independently associated with overall survival.ConclusionsPatients with stage IIIA small cell lung cancer treated with surgical resection plus chemotherapy demonstrated longer overall survival compared with those who underwent concurrent chemo-radiotherapy. Surgery may be an option for clinical stage IIIA small cell lung cancer after induction chemotherapy in selected patients.     

洛铂联合足叶乙甙治疗晚期小细胞肺癌的临床研究

目的观察评价新一代铂类抗癌药物洛铂（LBP）联合足叶乙甙（VP-16）组成的LE方案治疗晚期小细胞肺癌（SCLC）的有效性和安全性。方法26例经病理组织学和／或细胞学检查确诊SCLC,均为初治患者,其中男性22例,女性4例;年龄42～74岁,中位年龄61岁,TNM分期：ⅢA11例,ⅢB6例,Ⅳ期9例。应用LE方案,即LBP30mg／m^2静滴d1;VP-16100mg静滴d1～5;21～28d为一周期,至少接受2个周期化疗。按照WHO标准评价客观疗效和毒性。结果26例患者中,可评价疗效的患者有25例。其中CR3／25,PR20／25,NC2／25,有效率（RR）92．0％。主要毒性反应为可逆性的骨髓抑制和胃肠道反应。结论LBP联合VP-16组成LE方案治疗SCLC疗效好,毒性反应可以耐受,值得进一步研究观察。     

164例小细胞肺癌术后预后分析

目的探讨术后小细胞肺癌（SCLC）生存率的影响因素。方法对经手术治疗后确诊为小细胞肺癌的164例患者进行长期随访,并对患者术后生存率有影响的因素进行分析。结果Ⅰ、Ⅱ与Ⅲ期1年、3年、5年生存率间差异有显著统计学意义（P〈0.05）;手术切除＋术后化疗组和单纯手术组比较,1年、3年生存率间差异有显著统计学意义（P〈0.01）,两组在TNM分期下Ⅰ、Ⅱ、Ⅲa期1年、3年、5年生存率间差异有显著统计学意义（P〈0.05）;术式（肺全切和肺叶切）、年龄（〈60岁和≥60岁）和性别（男性和女性）1年、3年、5年生存率间差异无显著意义（P〉0.05）。结论 TNM分期、术后有无化疗对患者术后生存率有明显影响。     

Long-term survival in small cell lung cancer patients is correlated with high interleukin-2 secretion at diagnosis

Purpose: We have previously reported significant impairment of IL-2 secretion in patients with small cell lung cancer (SCLC) at the time of diagnosis. Impairment of IL-2 secretion correlated with reduced survival in SCLC. This new prognostic factor was independent of other factors of prognostic relevance in SCLC. The prognostic value of IL-2 secretion was comparable to the most predominant prognostic factors for survival in SCLC identified so far. We now report long-term survival data from these patients. Methods: The significance of correlations between single parameters in the test groups was calculated by using linear regression analysis, the Wilcoxon rank sum test, and Fisher's exact test. Using the Kaplan-Meier method, the log-rank test and the Cox regression model, we analyzed the relation of IL-2 secretion in whole blood cell cultures from 52 patients with SCLC at the time of diagnosis to established prognostic factors relevant for survival in SCLC. Results: IL-2 secretion correlates with survival in SCLC. In addition, survival analysis according to tumor response and level of IL-2 secretion at the time of diagnosis demonstrates that long-term survival can only be observed after complete response to chemotherapy and high initial IL-2 secretion. Conclusions: IL-2 secretion at the time of diagnosis represents an independent prognostic factor for survival in SCLC. Moreover, long-term survival is only observed in patients with complete response upon chemotherapy that showed high IL-2 secretion at diagnosis. Therefore, IL-2 secretion may partially define long-term survival in this disease. These results have to be confirmed in a larger patient population. Received: 7 February 1999 / Accepted: 12 May 2000     

Small cell lung cancer in young patients: trends in sociodemographic factors,diagnosis, treatment,and survival

BackgroundSmall cell lung cancer (SCLC) in patients <50 years old has unique socioeconomic and clinical implications. We aimed to examine the demographics, treatment patterns, and survival of young patients with SCLC and compared them to older adults.MethodsThe National Cancer Database (NCDB) was queried to identify SCLC cases diagnosed from 2004 to 2016. Patients were divided into three age groups: ≥18–<50, ≥50–<70, and ≥70 years. Patient characteristics were evaluated for survival within each age group. Kaplan-Meier and Cox regression analyses were used to assess survival.ResultsOf the 172,453 evaluated SCLC patients (median age 66 years), 8,792 were ≥18–<50 years old. Compared to the older groups, patients under 50 were more likely to be Black, uninsured or on Medicaid, have household income <$30,000, and present with stage III or IV disease (P<0.0001 for all). While young patients were more likely to receive guideline-concordant care (GCC), the hazard of death increased to 1.96 (95% CI: 1.80–2.14; P<0.0001) with receipt of nonstandard therapy. Private insurance, female gender, non-White race, Hispanic ethnicity, and higher income were associated with better survival. The youngest cohort had significantly better survival overall when compared to the older patients (P<0.0001), but the survival advantage was reduced with the advancing stage.ConclusionsSCLC patients under 50 years old represent a socioeconomically disadvantaged group with advanced disease at presentation. Despite having fewer comorbidities and being offered guideline-concordant treatment, younger patients with SCLC have only marginally better survival than older patients in advanced stages.     

An analysis of the outcomes of treatment of small cell lung cancer in the elderly

Abstract Background: Many cases of small cell lung cancer will occur in the elderly population but optimal management of the disease in this age group remains uncertain.
Aims: To evaluate treatment of small cell lung cancer in the elderly in Australia and to compare treatment received and outcomes with those of younger patients. To draw insights from these observations into the optimal management of small cell lung cancer in the elderly.
Methods: A retrospective review of treatment charts and case notes for 51 elderly patients and 102 younger patients was undertaken.
Results: Elderly patients had similar baseline parameters with respect to disease stage and performance status. Elderly patients were mostly treated uniformly with combination chemotherapy, but suffered more dose reductions than younger patients. Benefits of chemotherapy were seen even in patients with poor performance status. Despite the dose reductions, response rates and survival times for elderly patients were usually similar to younger patients.
Conclusions: Combination chemotherapy is beneficial to elderly patients with small cell lung cancer. Optimal therapy for the elderly may be different from that for younger patients and should be defined through prospective randomised clinical trials.     

与小细胞肺癌预后相关的血清学指标研究进展

有研究表明合适的肿瘤标记物能早期提示小细胞肺癌的预后,从而更好地指导临床治疗。血清学指标具有取样方便、创伤轻微、价格相对低廉等优势。所以,与小细胞肺癌预后相关的血清学指标的研究则颇具临床价值,本文就此方面的内容作一综述。     

肺癌铂类药物化疗敏感性与基因多态性的研究进展

铂类药物是非小细胞肺癌最常用的化疗药物。研究表明不同个体间对铂类药物化疗敏感性有显著性差异,这可能与个体遗传基因的多态性有关。因此,探讨非小细胞肺癌患者铂类药物化疗敏感性与基因多态性关系的研究对于临床个体化疗方案的制定具有重要的意义。     

以铂类为基础的两药联合方案治疗老年晚期非小细胞肺癌临床研究

目的 评价老年晚期非小细胞肺癌(NSCLC)患者接受以铂类为基础的两药联合化疗的疗效和安全性. 方法 对我院41例年龄≥70岁的老年晚期NSCLC患者应用以铂类为基础的两药联合方案化疗的情况进行了回顾性分析. 结果 41例患者中采用长春瑞滨方案的18例(43.9%),吉西他滨方案的9例(22.0%)、紫杉醇和多西紫杉醇方案各7例(17.1%).全组总有效率为19.5%,中位疾病进展时间和中位生存期分别为5.8个月和14.2个月,1年生存率为65.8%.化疗的主要不良反应为骨髓抑制,主要以白细胞和血小板减低为主,给予对症处理后可以恢复.患者无化疗相关死亡发生,有3例患者因出现Ⅲ～Ⅳ度骨髓抑制仪化疗1个周期. 结论 以铂类为基础的联合化疗方案治疗一般状况较好的老年晚期NSCLC疗效确切且耐受性较好.     

非小细胞肺癌患者临床疗效及预后的影响因素

目的 研究非小细胞肺癌(NSCLC)的临床疗效及相关预后因素.方法 2013年6月-2020年6月,于复旦大学附属华东医院呼吸科治疗的155例NSCLC患者,分为手术组(n=47)和非手术组(n=108).比较2组的临床特征,随访观察患者的中位总生存时间(OS)、中位无进展生存(PFS)及生存率,分析影响NSCLC预后...     

四种化疗方案治疗晚期非小细胞肺癌的疗效比较

目的 探讨不同化疗方案治疗晚期非小细胞肺癌的疗效。方法 114例晚期非小细胞肺癌患者分别用四组不同的方案化疗,vIP40例,NP36例,GP21例,TP17例,四组患者资料具有可比性。结果 VIP有效率42．5％,肿瘤控制率72．5％;NP有效率47．2％,肿瘤控制率80．6％;GP有效率52．4％,肿瘤控制率90．5％;TP有效率58．8％,肿瘤控制率94．1％。四种方案有效率比较无统计学差异（P〉0．05）,肿瘤控制率比较有统计学差异（P〈0．05）。结论 四种化疗方案均对晚期非小细胞肺癌有效,但TP方案在肿瘤控制率及化疗副反应方面占优势,而NP方案疗效比较高,可作为经济条件较差晚期NSCLC患者首选方案。     

Combination therapy with carboplatin and paclitaxel for small cell lung cancer

Background

Although small cell lung cancer (SCLC) is an aggressive cancer, few useful treatment options exist after relapse. Information concerning the efficacy and safety of carboplatin plus paclitaxel in patients with SCLC is limited.

非小细胞肺癌患者EGFR、ALK基因突变及临床病理特征与预后的相关性研究

目的探讨非小细胞肺癌(NSCLC)患者EGFR、ALK基因突变状态及病理特征,分析二者与患者预后情况相关性。方法收集2015年1月至2018年1月苏州大学附属第一医院病理确诊的NSCLC病例262例,记录患者临床病理特征及转归,采用突变增阻滞系统(ARMS)-Taqman探针法及RT-PCR检测患者肿瘤样本的EGFR和ALK基因外显子突变情况,采用Kaplan-Meier法和Cox风险回归考察不同基因突变情况的预后、临床病理特征与临床结局的相关性。结果262例NSCLC患者中,168例为野生型,ALK突变12例,突变率4.6%;EGFR突变82例,突变率31.30%,其中18号外显子突变2例,19号外显子突变37例,20号外显子突变9例,21号外显子突变31例;各组间年龄、病理类型比较差异有统计学意义,P<0.05;Wild type组中位OS时间11.6月,ALK组中位OS时间15.0月,EGFR组中位OS时间36.8月,EGFR组OS明显优于ALK组OS时间及Wild type组OS时间,P<0.05;EGFR19号外显子突变组、21号外显子突变组OS生存时间显著高于18号外显子突变组和20号外显子突变组,P<0.05;EGFR阴性(RR=15.751,95%CI:9.252~26.816)、鳞癌(RR=18.344,95%CI:6.187~54.388)为OS的危险因素。结论EGFR突变状态、病理类型对非小细胞肺癌预后具有良好的预测价值,鳞癌和EGFR阴性患者生存期短。EGFR基因少见突变(18号外显子、20号外显子)患者的中位OS时间更短。     

深部热疗联合化疗在晚期小细胞肺癌中的疗效观察

目的探讨深部热疗结合化疗在晚期小细胞肺癌中的临床效果。方法将80例晚期小细胞肺癌患者随机平均分成治疗组和对照组,每组各40例。2组患者均采用依托泊苷联合顺铂常规化疗治疗,治疗组患者在化疗同时给予肺部原发病灶深部热疗;比较6周期后两组患者的缓解率、无进展生存期、体能变化及不良反应。结果治疗组患者的缓解率为85.0%,对照组患者的缓解率为67.5%,治疗组缓解率显著高于对照组(P<0.05);治疗组的无进展生存期明显高于对照组(P<0.05);治疗组KPS评分较化疗前明显增加(P<0.05),对照组KPS评分较化疗前比较差异无统计学意义;2组患者的恶心、呕吐、及骨髓抑制程度明显低于对照组,但均无统计学意义(P>0.05)。结论晚期小细胞肺癌患者在化疗的同时联合深部热疗可显著提高患者的化疗疗效,延长患者生存时间,减轻患者化疗的不良反应,提高患者生存质量。     

紫杉醇+顺铂二线治疗小细胞肺癌38例临床观察

目的 研究紫杉醇+顺铂二线治疗复治小细胞肺癌患者的疗效和毒副反应.方法 纳入一线含铂方案(依托泊苷+卡铂)化疗失败患者38例,采用紫杉醇135 mg/m2,第1天;顺铂70 mg/m2,第1～3天,每3～4周为1个周期,连用2～4个周期.结果 部分缓解12例,稳定14例,进展12例,总有效率31.6％(12/38),疾病控制率68.4％(26/38),总生存期10.5个月,中位生存期6.8个月.化疗敏感者有效率39.3％(11/28);化疗耐药者有效率10.0％(1/10).本组38例均可评价毒副反应,Ⅲ度以上白细胞及中性粒细胞减少分别为47.4％(18/38)、57.9％(22/38).Ⅳ度中性粒细胞减少15.8％(6/38).中性粒细胞减少性发热10.5％(4/38).主要非血液学毒副反应是乏力、恶心呕吐、周围神经毒性,Ⅲ度以上毒性反应是乏力55.3％(21/38)、恶心呕吐31.6％(12/38).结论 紫杉醇+顺铂治疗复治小细胞肺癌有效且毒副反应可耐受.     

Neuron - specific enolase predicts the prognosis in advanced small cell lung cancer patients treated with first-line PD-1/PD-L1 inhibitors

There has been no effective biomarker for small cell lung cancer (SCLC) patients with first-line immune checkpoint inhibitors (ICIs) treatment. The predictive value of neuron-specific enolase (NSE) in this cohort remains unclear.The medical records of 254 consecutive SCLC patients receiving programmed cell death receptor-1/programmed cell death-ligand 1 (PD-1/PD-L1) inhibitors were compiled from January 2015 to October 2020 in Chinese PLA General Hospital. Survival analysis was performed to explore the prognostic role of NSE at baseline and 3 weeks post treatment.One hundred two advanced SCLC patients treated with first-line PD-1/PD-L1 inhibitors were enrolled in this study. Normal baseline NSE levels were correlated with significantly prolonged progression-free survival (PFS, median: 8.7 vs 4.7 months, P = .006) and overall survival (OS, median: 23.8 vs 15.2 months, P = .014) compared with elevated baseline NSE levels, so as for normal NSE levels at 3 weeks with prolonged PFS (median PFS: 8.4 vs 4.5 months, P = .0002) and OS (median OS: 23.3 vs 7.4 months, P < .0001). Intriguingly, elevated NSE levels at 3 weeks were associated with shorter PFS (median PFS: 4.5 vs 5.8 months, P = .04) and OS (median OS: 5.5 vs 14.7 months, P < .0001) compared with normal NSE levels in the elevated baseline NSE subgroup. Most subgroup analyses stratified by clinical characteristics confirmed the prognostic value of baseline NSE level.Elevated NSE levels at baseline and 3 weeks were associated with worse prognosis in advanced SCLC patients receiving first-line ICIs treatment. NSE level might be applied as a useful prognostic tool for SCLC patients with immunotherapy.     

奈达铂联合化疗治疗晚期非小细胞肺癌

目的评价奈达铂联合长春瑞滨治疗晚期非小细胞肺癌的疗效和不良反应。方法对28例初治晚期非小细胞肺癌行奈达铂联合长春瑞滨化疗,方案：奈达铂80mg／m^2静滴d1。长春瑞滨25mg／m^2静注d1、d8,3～4周为一周期,用药4周期。对照组25例,化疗方案为顺铂加长春瑞滨。结果奈达铂组PR11例,有效率（CR＋PR）为39．2％;对照组CR1例、PR8例,有效率40．0％,两组间差异不明显（P〉0．05）;毒性反应白细胞与血小板减少治疗组与对照组无显著性差别（P〉0．05）;消化道反应奈达铂组明显小于顺铂组（P〈0．05）。结论奈达铂联合化疗治疗晚期非小细胞肺癌的疗效与顺铂相当,消化道毒性小于顺铂。奈达铂联合长春瑞滨化疗是治疗晚期小细胞肺癌较为有效的化疗方案之一。     

加速超分割放疗联合化疗治疗局限期小细胞肺癌的疗效分析

目的探讨加速超分割胸腔放疗联合EP方案治疗局限期小细胞肺癌的疗效及安全性。方法共72例局限期小细胞肺癌随机分为加速超分割组和常规分割组,其中加速超分割组放疗1.5 Gy/次,2次/日,间隔6小时,总量45Gy;常规分割组1.8～2 Gy/次,1次/日,总量50 Gy。两组全部采用EP方案化疗4～6周期。结果加速超分割组与常规分割组的有效率分别为82.8%和59.4%(P<0.05),加速超分割组与常规分割组的1年、2年和3年生存率分别为90.7%vs 83.1%、55.2%vs43.8%和25.4%vs 17.6%(P<0.05)。主要毒性反应为白细胞减少和放射性食管炎,超分割组的白细胞减少与放射性食管炎较常规分割组有所升高(P<0.05),但均可耐受。结论加速超分割放疗联合EP方案化疗提高了局限期小细胞肺癌的疗效,同时增加了骨髓抑制、放射性食管炎等急性放射性损伤,但是毒性反应可以耐受,值得进一步推广应用。     

Circulating antineuronal antibodies in small cell lung cancer

Antibodies directed against neuronal cells were found in the serum of 10 out of 27 patients with small cell lung cancer (SCLC) by means of an indirect immunofluorescent test. Positive staining was found either in nuclei of neurons with sparing of nucleoli or in the cytoplasm only. Antibodies belonged to IgG or IgM. A comparison with a control group of 60 patients yielded a high specificity of the circulating antibodies for SCLC. Contrary to recent reports, we were not able to confirm an association between the existence of circulating antibodies against neurons and the incidence of neurologic paraneoplastic disorders.