混合型小细胞肺癌外科治疗后预后分析

  目的  探索混合型小细胞肺癌（C-SCLC）术后患者生存的预后影响因素。  方法  回顾性分析2010年1月至2014年12月在上海交通大学附属胸科医院行肺癌根治性切除及系统性淋巴结清扫C-SCLC患者的临床资料。  结果  共计78例患者入组，其中C-SCLC合并大细胞神经内分泌肿瘤（large cell neuroendocrine carcinoma，LCNEC）患者所占比例最多（n=42），其次是C-SCLC合并鳞癌（SCC）患者（n=18）、C-SCLC合并腺癌（AC）患者（n=10）及C-SCLC合并腺鳞癌（ASC）患者（n=8）。本研究队列5年生存率（OS）39.1%。多因素Cox回归分析表明:肿瘤大小[ < 3 cm vs. >3 cm；危险度（HR）=0.406；95%可信区间（95%CI）:0.202~0.816；P= 0.011]、体力状态评分（ < 2 vs. >2；HR=0.113；95%CI:0.202-0.631；P=0.013）、混合性非小细胞肺癌（NSCLC）成分（LCNEC vs.非LCNEC成分，HR=3.00；95%CI:0.096~0.483；P < 0.001）、病理分期（ⅢA期vs. Ⅰ期；HR=0.195，95%CI:0.063-0.602；P=0.004）及辅助治疗（是vs.否，HR=0.402；95%CI:0.195~0.831；P=0.014）为C-SCLC患者预后影响因素。  结论  混合型小细胞肺癌中的大细胞神经内分泌肿瘤成分会显著影响患者生存；术后辅助治疗明显有益于C-SCLC术后患者生存率的提高。 

Prognostic factors of combined small cell lung cancer after surgical resection

Objective:To investigate the prognostic factors and survival of patients with combined small cell lung cancer (C-SCLC) after they underwent complete resection. Methods:The clinical records of C-SCLC patients who were subjected to complete resection and systematic nodal dissection in one institution between January 2010 and December 2014 were retrospectively reviewed. Results:Sev-enty-eight patients with histologically diagnosed C-SCLC were identified. The most common combined component was large cell neuro-endocrine carcinoma (LCNEC) (n=42), followed by squamous cell carcinoma (SCC) (n=18), adenocarcinoma (AC) (n=10), and adenosqua-mous carcinoma (ASC) (n=8). The overall survival (OS) rate of the entire cohort was 39.1%. Multivariate analyses using Cox's propor-tional hazard models revealed that size [<3 cm vs.>3 cm;hazard ratio (HR)=0.406;95%confidence interval (CI)=0.202-0.816;P=0.011], performance status (<2 vs.>2;HR=0.113;95%CI=0.202-0.631;P=0.013), combined non-small cell lung cancer (NSCLC) components (LCNEC vs. non-LCNEC, HR=3.00;95%CI=0.096-0.483;P<0.001), stage Ⅲ A vs.Ⅰ;HR=0.195, 95%CI:0.063-0.602;P=0.004) and adju-vant therapy (yes vs. no, HR=0.402;95%CI=0.195-0.831;P=0.014) were significant prognostic factors of OS. Conclusion:The mixed NSCLC components within C-SCLC significantly influence survival. Adjuvant therapy is beneficial for patients with complete resection of C-SCLC.