新辅助化疗加手术在可切除小细胞肺癌中的疗效分析

目的探讨可手术切除小细胞肺癌以外科手术为主综合治疗的意义。方法回顾性分析2000年1月至2005年1月外科治疗82例小细胞肺癌的临床与生存资料,根据综合治疗方案中手术与化疗的先后顺序将本组患者分为新辅助化疗组(NAC组)与直接手术组。结果 NAC组53例,术前经1～2周期EP方案(足叶乙甙、顺铂)新辅助化疗,有效率81.1%(43/53),3例组织学完全缓解;直接手术组29例。NAC组1、3、5年生存率分别为86.8%、49.1%、28.3%,显著高于直接手术组的79.3%、31.0%、10.3%(P均<0.05),中位生存时间分别为36个月、25个月。结论可手术切除小细胞肺癌应采取以外科手术为主的综合治疗策略,术前确诊并采用NAC能够进一步提高长期生存率。

The value of preoperative neoadjuvant chemotherapy and surgery in treating resectable small cell lung cancer

Objective To evaluate the value of preoperative neoadjuvant chemotherapy(NAC)and surgery in the treatment of resectable small cell lung cancer(SCLC).Methods Retrospective study was performed on the clinical and survival data from 82 patients with resectable SCLC who received surgical resection during Jan 2000 to Jan 2005.All patients were divided into two groups:NAC group(preoperative NAC followed by surgery)and control group(surgery without NAC).Results NAC group had 53 patients and control group had 29 cases.The patients in NAC group were given 1 or 2 cycles of NAC with EP(etoposide and cisplatin)regimens,and operations were performed in 2 or 3 weeks after finishing the last chemotherapy.The tumor response to NAC was 81.1%(43/53).3 cases had histological complete response.The 1-,3-,5-year survival rates were 86.8%,49.1%,28.3% in NAC group,and 79.3%,31.0%,10.3% in control group respectively.The long-term survival rate in NAC group was remarkably higher than control group(P<0.05).The median overall survivals were 36 and 25 months respectively.Conclusions Combined therapy with surgery as the main treatment should be adopted in resectable SCLC.A definite pathological diagnose and NAC before operation could improve long-term survival furtherly.