手术对切除前未确诊的小细胞肺癌患者生存期的影响。

IF 2.1 4区 医学 Q3 CARDIAC & CARDIOVASCULAR SYSTEMS Annals of Thoracic Medicine Pub Date : 2024-10-01 Epub Date: 2024-10-03 DOI:10.4103/atm.atm_42_24
Brice Caput, Laura Peretti, Stephanie Lacomme, Angelica Tiotiu
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引用次数: 0

摘要

背景:局限期小细胞肺癌(SCLC)的治疗标准包括放化疗。手术治疗在这一适应症中的地位仍存在争议。本研究旨在评估法国南锡大学医院因切除前未确诊的小细胞肺癌而接受手术治疗的患者的总生存率(OS)。其次,分析手术对无复发生存率(RFS)的影响:方法:纳入1991年至2018年期间在胸外科接受肺切除术、术后诊断为SCLC的所有患者。根据切除类型、术后分期和淋巴结扩展情况分析OS和RFS:结果:共纳入61例患者。肺叶切除术患者的中位OS高于肺切除术患者(26 [8.4-208.7] 个月 vs. 12 [3.4-27.6] 个月,P < 0.001),I期患者的中位OS高于其他分期患者(58 [8.4-208.7] 个月 vs. 17 [3.4-83.5] 个月,P = 0.002),N0-1期患者的中位OS高于N2期患者(25 [3.6-208.7] 个月 vs. 15 [3.4-83.5] 个月,P = 0.01)。肺叶切除术后的RFS也明显高于肺切除术后(17 [1.6-184.9] vs. 8 [0.5-17.6],P < 0.001),I期明显高于II-III期(35 [5-184.9] vs. 11 [0.5-42.4],P < 0.001),N0-1明显高于N2(25 [1.6-184.9] vs. 9 [0.5-16.5]个月,P = 0.006)。在多变量分析中,影响OS的唯一独立因素是肺切除术(危险比=3.19;95%置信区间[1.46-6.98],P=0.004):结论:I期SCLC的手术切除可改善OS和RFS。N1期患者不应自动被排除在手术之外。肺叶切除加区域淋巴结切除术是较好的手术选择。
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Effect of surgery on survival of patients with small-cell lung cancer undiagnosed before resection.

Background: Standards of treatment for limited-stage small-cell lung cancer (SCLC) include chemoradiotherapy. The place of the surgery in this indication is still debated. The objective of this study was to evaluate the overall survival (OS) in patients who underwent surgery for an SCLC undiagnosed before resection in the University Hospital of Nancy, France. Secondarily, the impact of surgery on recurrence-free survival (RFS) was analyzed.

Methods: All the patients who underwent lung resection in the Department of Thoracic Surgery, from 1991 to 2018, and a diagnosis of SCLC after surgery were included. OS and RFS were analyzed according to the resection type, postoperative staging, and lymph node extension.

Results: Sixty-one patients were included. The median OS was higher in patients with lobectomy than those with pneumonectomy (26 [8.4-208.7] vs. 12 [3.4-27.6] months, P < 0.001) in stage I compared to other stages (58 [8.4-208.7] vs. 17 [3.4-83.5] months, P = 0.002), and N0-1 than N2 (25 [3.6-208.7] vs. 15 [3.4-83.5] months, P = 0.01). RFS was also significantly higher after lobectomy than after pneumonectomy (17 [1.6-184.9] vs. 8 [0.5-17.6], P < 0.001), stage I than stages II-III (35 [5-184.9] vs. 11 [0.5-42.4], P < 0.001) and N0-1 compared to N2 (25 [1.6-184.9] vs. 9 [0.5-16.5] months, P = 0.006). In multivariate analysis, the only independent factor influencing the OS was the pneumonectomy (hazard ratios = 3.19; 95% confidence interval [1.46-6.98], P = 0.004).

Conclusion: Surgical resection of stage I SCLC may lead to better OS and RFS. N1 patients should not automatically be excluded from surgery. Lobectomy with regional lymph node resection is the preferable choice of surgery.

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来源期刊
Annals of Thoracic Medicine
Annals of Thoracic Medicine CARDIAC & CARDIOVASCULAR SYSTEMS-RESPIRATORY SYSTEM
CiteScore
4.10
自引率
4.30%
发文量
19
审稿时长
>12 weeks
期刊介绍: The journal will cover studies related to multidisciplinary specialties of chest medicine, such as adult and pediatrics pulmonology, thoracic surgery, critical care medicine, respiratory care, transplantation, sleep medicine, related basic medical sciences, and more. The journal also features basic science, special reports, case reports, board review , and more. Editorials and communications to the editor that explore controversial issues and encourage further discussion by physicians dealing with chest medicine.
期刊最新文献
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