Background: Small cell lung cancer accounts for about 15%-25% of lung cancer, although the new chemotherapy drugs and radiation technology are continuously progressing, but the prognosis is still poor. To explore the prognostic factor of small cell lung cancer (SCLC), we study the correlation between effect, prognosis and TNM stage, various treatment mode.
Methods: We collected 91 Limited-disease-SCLC patients' data From 2006 to 2012. The data were reviewed retrospectively and restaged as I, II, IIIa and IIIb stage groups according to the clinical staging in the seventh edition of the tumor. We compare the progression-free survival (FPS) and overall survival (OS). Survival analysis was evaluated by Kaplan-Meier and multivariate analysis was performed by Cox proportional hazards model.
Results: In the whole group, patients achieved complete response and partial response, exhibited an RR of 93.4%. The median PFS was 14.25 months of which, 22.03 months in patients in stage I, 15.97 months in stage II, 11.99 months in stage IIIa and 10.5 months in stage IIIb (P<0.05). The median overall survival (OS) was 19.56 months of which, 33.38 months in patients in stage I, 22.07 months in stage II, 16.0 months in stage IIIa and 15.52 months in stage IIIb (P<0.05). Patients of stage IIIa and IIIb have longer survival time in earlier radiation groups then that of later radiation groups. Univariate analysis indicate stage of TNM, the pattern of radiation therapy and chemotherapy cycles before radiation therapy were significantly related to the survival in SCLC. Multivariate analysis showed that stage of TNM, ECOG (Eastern Cooperative Oncology Group) performance status, pattern of radiation therapy and cycle numbers of chemotherapy before radiation were factors correlated with survival.
Conclusions: The stage of TNM may become beneficial prognostic factors in the treatment of LD-SCLC. The time of radiation therapy in stage IIIa and IIIb is of worth further investigation.
背景与目的 小细胞肺癌（small cell lung cancer, SCLC）约占新发肺癌的15%-25%，尽管新型化疗药物及放疗技术不断进展，但预后仍较差，为进一步探讨局限期SCLC的预后因素，回顾性评价不同TNM分期、不同治疗模式对局限期SCLC疗效及预后的影响。方法 收集2006年1月-2012年3月期间吉林省肿瘤医院胸部肿瘤内科收治的资料完整经过序贯化放疗的局限期SCLC共91例，根据2009年国际肺癌组织分期系统回顾性的将局限期患者分为I期、II期、IIIa期和IIIb期组，比较4组的近期疗效、无进展生存期（progression-free survival, PFS）和生存期（overall survival, OS），采用Kaplan-Meier法行生存分析，Cox比例风险模型行多因素回归分析。结果 全组患者的RR率为93.4%；全组中位PFS 14.25个月，I期、II期、IIIa期、IIIb期的中位PFS分别为：22.03个月、15.97个月、11.99个月和10.5个月，其中I期和IIIa期、IIIb期的中位PFS有统计学差异（P<0.05）；中位OS为19.56个月，I期、II期、IIIa期、IIIb期的中位生存期分别为：30.38个月、22.07个月、16.0个月和15.25个月，其中I期、II期和IIIa期、IIIb期的中位生存期有统计学差异（P<0.05）。IIIa期和IIIb期病例早放疗与晚放疗比较，晚放疗组生存期优于早放疗组，并有统计学差异（P=0.011）。单因素分析表明TNM分期、放疗方式和放疗前化疗周期数是影响患者预后的主要因素。Cox分析表明TNM分期、PS评分、放疗前化疗周期数和放疗方式是影响总生存时间的独立预后因素。结论 TNM分期是局限期SCLC的较好预后因素，本研究显示III期SCLC晚放疗有生存获益，对于IIIa期和IIIb期局限期SCLC患者放疗时机的选择有待进一步研究，SCLC应用TNM分期更有利于指导治疗和预后。