Background: Currently, the prognosis of lobectomy and sub-lobectomy for the treatment of stage Ia small cell lung cancer (SCLC) is rarely reported. We retrospectively studied T1N0M0 (≤3 cm) SCLC patients aged ≥60 years, aiming to comparatively analyze the prognosis of lobectomy and sub-lobectomy in treating patients with Ia SCLC.
Methods: Patients with stage Ia SCLC diagnosed by pathologic between 1992 and 2010 were selected from the "Surveillance, Epidemiology and End Results database"(SEER). Outcome data were compared using Kaplan-Meier (Log-rank test) and Cox model multivariate analysis.
Results: We identified 515 patients. Median overall survival (OS) of the lobectomy (n=110), sublobar resection (n=57) and non-surgical (n=348) cohort were 45, 23 and 16 months, respectively. The corresponding 5-year OS of the three groups were 44%, 30%, and 14%, respectively. No significant difference in the prognosis of patients with or without lymph node examination/ dissection (P=0.107) and the 5-year OS of patients underwent lobectomy with chemoradiation was 50%. Cox multivariable analysis showed that operation treatment, including lobectomy and sublobectomy, was one of the independent factors associated with the prognosis of early SCLC patients, and patients undergo lobectomy shows a better OS compared with sublobar resection (Lob vs Sub, HR=0.645; 95%CI: 0.433-0.961, P=0.031).
Conclusions: For age ≥60 years T1N0M0 (≤3 cm) SCLC patients, we recommend anatomical lobectomy combined with adjuvant chemoradiation.
背景与目的 目前，肺叶切除与亚肺叶切除治疗Ia期小细胞肺癌（small cell lung cancer, SCLC）的预后比较鲜有报道。本研究通过对年龄≥60岁的T1N0M0（≤3 cm）SCLC进行回顾性研究，旨在探索肺叶切除与亚肺叶切除治疗Ia期SCLC预后的对比分析。方法 纳入“监测，流行病学和结果数据库”（Surveillance, Epidemiology and End Results database, SEER）在1992年-2010年间经病理诊断为Ia期SCLC患者共515例，数据使用Kaplan-Meier（Log-rank检验）和Cox模型进行比较统计分析。结果 肺叶切除组（n=110）、亚肺叶切除组（n=57）、和非手术治疗组（n=348）的中位生存期分别为45个月、23个月和16个月；该三组相应的5年总生存期（OS）分别为44%、30%和14%（Lob vs Sub, χ²=4.851, P=0.028; Sub vs non-surgical, χ²=6.529, P=0.011）。SCLC有、无淋巴结采样/清扫患者的预后无显著差异（P=0.107）；肺叶切除+放化疗组（Lob+CR, n=59）的5年OS为50%。Cox分析证实，手术（肺叶与亚肺叶切除术）方式为独立预后预测因素之一。结论 年龄≥60岁的Ia期SCLC患者，我们推荐解剖性肺叶切除联合辅助放化疗治疗。.
Keywords: Lobectomy; Prognosis; Radiochemotherapy; SCLC; Sub-lobectomy.