手术对广泛期小细胞肺癌患者生存的影响:基于SEER数据库的倾向得分匹配分析

目的:探讨手术治疗与非手术治疗对广泛期小细胞肺癌（ES-SCLC）患者的影响。方法:收集SEER数据库2004—2015年共24 677例ES-SCLC患者并将其分为手术组和非手术组，通过倾向得分匹配分析消除两组间的偏差，用Kaplan-Meier生存分析比较两组的生存情况，利用Log-rank单因素分析和多因素Cox回归对ES-SCLC患者进行校正并进行亚组分层分析。结果:倾向得分匹配后各有249例患者纳入手术组和非手术组，两组Kaplan-Meier生存曲线显示手术组预后较好且有统计学意义（χ2=13.367，P<0.001）。手术组中，接受肺叶切除术者比接受肺段、全肺切除术者预后生存率更佳（χ2=16.447，P<0.001）。单因素和多因素分析结果显示，手术治疗是影响ES-SCLC患者预后的因素（χ2=13.367，P<0.001）。亚组分析显示，≥60岁、N0和N1的手术组患者预后优于非手术组（χ2=8.974、7.732、4.077，P=0.003、0.005、0.043），同时，无论是否化疗，手术组预后均优于非手术组（χ2=8.072、4.104，P=0.004、0.043）。结论:手术总体上可以延长ES-SCLC患者的生存时间。

Effect of surgery on survival in patients with extensive small cell lung cancer:a SEER database-based propensity scores matching analysis

Objective: To investigate the effect of surgical treatment and non-surgical treatment on the prognosis of patients with extensive stage small cell lung cancer（ES-SCLC）. Methods:A total of 24 677 ES-SCLC patients from 2004 to 2015 were collected from SEER database and divided into surgery group and non-surgery group. Deviation between the two groups was eliminated by tendency score matching analysis. Survival of the two groups was compared by Kaplan-Meier survival analysis. The subgroup analysis was corrected and analyzed by Log-rank univariate analysis and multivariate Cox regression. Results:After propensity score matching，surgery group and non-surgery group each involved 249 patients. The difference between the two Kaplan-Meier survival curves was statistically significant （χ2=13.367，P＜0.001）. In surgery group，patients with pulmonary lobectomy had a better survival rate than those who received segmentectomy or pneumonectomy（χ2=16.447，P＜0.001）. Univariate and multivariate analysis showed surgery was an independent prognostic factor in patients with ES-SCLC（χ2=13.367，P＜0.001）. In subgroup analysis，patients aged 60 or more and with stage N0 and N1 in surgery group had better prognosis than those in non-surgery group（χ2=8.974，7.732，4.077，P=0.003，0.005，0.043）. Meanwhile，regardless of whether patients received chemotherapy，there was difference between prognosis of surgery group and non-surgery group（χ2=8.072，4.104，P=0.004，0.043）and the former was better. Conclusion:In general，the operation can prolong the survival time of ES-SCLC patients.