小细胞肺癌术后放疗的临床意义分析

分析术后放疗在Ⅰ～Ⅲ期小细胞肺癌患者综合治疗中的地位。方法:回顾性分析2000年2月至2009年12月间天津医科大学附属肿瘤医院有完整记录的接受手术治疗的Ⅰ～Ⅲ期小细胞肺癌患者临床资料，分析术后放疗对小细胞肺癌患者预后的影响。采用Kaplan-Meier法及Cox回归模型分析术后放疗的价值。结果:全组患者3年生存率为45.8%，中位生存期为34个月。单因素及多因素分析均显示术后放疗没有显著增加生存率，但是显著降低了局部区域复发率。术后放疗组与未放疗组的3年生存率分别为49.7%和39.3%，中位生存期分别为36个月和30个月（P=0.260）；3年局部区域复发率分别为7.7%和28.8%（P=0.001）。pN0患者术后放疗组与未放疗组3年生存率分别为54.5%和64.3%（P=0.705），pN1患者分别为53.8%和33.3%（P=0.067），pN2患者分别为46.7%和22.7%（P=0.141）。结论:术后放疗可明显降低小细胞肺癌术后局部复发率，可能会提高淋巴结阳性患者生存期。建议小细胞肺癌术后淋巴结阳性患者行术后放疗。 

Clinical Significance of Postoperative Radiotherapy in the Treatment of Small Cell Lung Canger after Surgery

To evaluate the role of post-operative radiotherapy ( PORT ) in the treatment of stage I-III small cell lung cancer ( SCLC ) after surgery, as well as to study the indication of PORT in patients with stage I-III SCLC. Methods: Patients with stage I-III SCLC treated with surgery in Tianjin Medical University Cancer Institute and Hopital between January 1998 and December 2009 were retrospectively analyzed, and the effect of PORT on their prognosis was evaluated. Out of the eligible 98 patients, 39 patients had pathological stage N0 disease, 22 had N1 disease, and 37 had N2 disease. As to the treatment, 8 patients underwent surgery, 41 patients underwent pre-operative chemotherapy, 86 received post-operative chemotherapy, and 39 of patients received post-operative radiotherapy. Kaplan-Meier and Cox regression model were used to analyze the role of PORT. Results: The median survival for the whole group was 34 months, and the 3-year overall survival ( OS ) was 45.8%. Both the univariate and multivariate analyses showed that PORT did not significantly improve the overall survival, but significantly reduced local-regional recurrence. The 3-year OS for the PORT and non-PORT group were 49.7% and 39.3%, and the median survival were 36 months and 30 months, respectively ( P = 0.260 ). The 3-year local-regional recurrence rate were 7.7% and 28.8%, respectively ( P = 0.001 ). The 3-year OS for pN0 patients with and without PORT were 54.5% and 64.3%, respectively ( P = 0.705 ), were 53.8% and 33.3% for pN1 patients ( P = 0.067 ), and 46.7% and 22.7% ( P = 0.141 ) for pN2 patients. Conclusion: PORT could reduce the local-regional recurrence of SCLC significantly, as well as the improvement of the overall survival rate of lymph node positive patients. Moreover, PORT may be considered for patients that still have lymph node positive SCLC after surgery.