摘要目的 比较手术与放化疗治疗局限期小细胞肺癌(SCLC)患者的总生存(0S)、无进展生存(PFS)、颅内无进展生存(BMFS)预后差异.方法 收集2000-2016年在浙江省肿瘤医院经手术治疗的局限期SCLC患者69例,在503例经根治性放化疗的局限期SCLC数据库中,按照T、N分期,治疗年份,年龄,性别,是否预防性脑照射(PCI)等进行1:1匹配69例患者为放化疗组.结果 共纳入138例患者,手术组69例(Ⅰ期24例、Ⅱ期14例、Ⅲ期31例),放化疗组69例(Ⅰ期24例、Ⅱ期14例、Ⅲ期31例).手术组与放化疗组的中位OS期分别为37.1个月(95％CI为24.1～50.2个月)和45.0个月(95％CI为15.8～74.2个月),2、5年OS率分别为60％、45％和64％、45％(P=0.846);中位PFS期分别为27.1个月(95％CI为0.00～60.3个月)和36.2个月(95％CI为20.9～51.4个月),2、5年PFS率分别为52％、38％和56％、40％(P=0.610).2、5年BMFS率分别为80％、76％和84％、80％(P=0.774).Ⅰ期手术组、放疗组5年OS率分别为62％、40％(P=0.038),PFS率分别为80％、40％(P=0.048),BMFS率分别为92％、95％(P=0.816).Ⅱ期手术组、放化疗组5年OS率分别为41％、51％(P=0.946),PFS率分别为65％、42％(P=0.280),BMFS率分别为75％、78％(P=0.720).Ⅲ期手术组、放化疗组5年OS率分别为25％、48％ (P=0.220),5年PFS率分别为28％、36％(P=0.333),5年BMFS率分别为76％、74％(P=0.842).结论 手术治疗可为Ⅰ期患者带来生存获益,Ⅱ期患者两组生存相当,Ⅲ期患者放化疗组有更好生存趋势.最终结论需要更大样本或开展前瞻性研究得出.

abstractsObjective To compare the overall survival (OS),progression-free survival (PFS) and brain metastasis free survival (BMFS) between the chemo-radiotherapy and surgical treatment for patients with limited stage small cell lung cancer (LS-SCLC).Methods Clinical data of 69 patients diagnosed with LS-SCLC undergoing surgery in Zhejiang Cancer Hospital between 2000 and 2016 were collected.According to T,N stage,treatment duration,age,gender and whether or not prophylactic cranial irradiation (PCI),69 patients of 503 LS-SCLC patients who underwent standard radiochemotherapy were assigned into the radiochemotherapy group by using the pair-matched case-control method.Results Among 138 patients,69 cases were allocated into the surgery group (24 cases of stage Ⅰ,14 cases of stage Ⅱ and 31 cases of stage Ⅲ) and 69 cases in the radiochemotherapy group (24 cases of stage Ⅰ,14 cases of stage]Ⅱ and 31 cases of stage Ⅲ).The median OS time was 37.1 months (95％CI:24.1-50.2 months) in surgery group and 45.0 months (95％CI:15.8-74.2 months) in the radiochemotherapy group.The 2-and 5-year OS rates were 60％ and 45％ in the surgery group,and 64％ and 45％ in the radiochemotherapy group (P=0.846).The median PFS time was 27.1 months (95％CI:0.00-60.3 months) in the surgery group and 36.2 months (95％CI:20.9-51.4 months) in the radiochemotherapy group.The 2-and 5-year PFS rates were 52％,and 38％ in the surgery group,and 56％ and 40％ in the chemo-radiotherapy group (P=0.610).The 2-and 5-year BMFS rates were 81％ and 76％ in the surgery group,and 84％ and 80％ in the radiochemotherapy group (P=0.774).The 5-year OS rate (62％ vs.40％,P=0.038) and 5-year PFS rate (80％ vs.40％,P=0.048) for patients with stage Ⅰ LS-SCLC in the surgery group were significantly higher than those in the radiochemotherapy group.However,the 5-year BMFS rate in patients with stage Ⅰ LS-SCLC did not significantly differ between two groups (92％ vs.95％,P=0.816).The 5-year OS rate (41％ vs.51％,P=0.946),5-year PFS rate (65％ vs.42％,P=0.280) and 5-year BMFS rate (75％ vs.78％,P=O.720) for stage Ⅱ SCLC did not significantly differ between two groups.As for stage Ⅲ SCLC patients,the OS rate (25％ vs.48％,P=0.220),5-year PFS rate (28％ vs.36％,P=0.333) and 5-year BMFS rate (76％ vs.74％,P=0.84) did not significantly differ between two groups.Conclusions Surgical treatment can bring survival benefits to patients with stage Ⅰ LS-SCLC.The survival prognosis of stage [[patients is equivalent between two groups.Patients with stage Ⅲ LS-SCLC receiving radiochemotherapy obtain better survival trend compared with those undergoing surgery.The conclusion remains to be validated by studies with larger sample size or prospective investigations.