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背景和目的小细胞肺癌虽然是一种对放化疗敏感的肿瘤,但预后却很差,局限期小细胞肺癌2年生存率仅18％～32％,因而分析初程治疗后失败模式及其预后影响因素对改善小细胞肺癌疗效有重要的临床意义。本研究拟总结我院局限期小细胞肺癌初程治疗后远处转移和局部失败的情况,并分析再程治疗的结果及意义。方法我院1974～1996年间共收治712例初治的局限期小细胞肺癌患者,回顾性分析首程治疗后初次局部失败和远处转移率、不同失败模式的再程治疗及预后影响因素。结果本组456例病例初次治疗局部失败和/或远处转移,治疗总失败的中位时间8.4个月,2年治疗总失败率为75.0％。其中远处转移(远处转移+远处转移伴局部失败)324例,中位时间8.1个月,2年远处转移率61.3％;局部失败(局部失败+局部失败伴远处转移)194例,中位时间9.1个月,2年局部失败率为35.3％。主要转移部位依次是脑42.3％(137/324),肝32.1％(104/324),骨31.2％(101/324),肾上腺25.6％(83/324),肺14.2％(46/324),皮肤6.5％(21/324)。局部失败和远处转移后中位生存1、2、3年生存率:再程治疗组分别为5.3月、17.5％、10.5％和5.3％,未治疗组分别为3.3月、17.4％、4.3％和2.2％,再程治疗组优于未治疗组(X~2=10.28,P=0.001)。再程治疗接受化放疗综合治疗组中位生存期为8.6月,优于单纯化疗和单纯放疗的5.1和4.6个月(X~2=5.9,P=0.053)。结论远处转移为局限期小细胞肺癌的主要失败模式;再程治疗能延长局限期小细胞肺癌复发转移患者的生存期;在病人可耐受的条件下,再程治疗应以放化疗综合治疗为主。
Background and objective Although small-cell lung cancer is a chemosensitive tumor, the prognosis is poor. The 2-year survival rate of SCLC is only 18% -32%. Therefore, the failure mode and its prognosis after initial treatment Factors affecting the improvement of small cell lung cancer have important clinical significance. This study intends to summarize the distant metastasis and local failure after initial treatment of SCLC in our hospital and to analyze the results and significance of re-treatment. Methods A total of 712 patients with locally advanced small cell lung cancer were treated in our hospital from 1974 to 1996. The primary failure rate and distant metastasis after first course of treatment were retrospectively analyzed. The re-treatment and prognostic factors of different failure modes were retrospectively analyzed. Results The initial treatment of 456 cases of this group of local failure and / or distant metastasis, the median total failure time of 8.4 months, 2-year total treatment failure rate of 75.0%. There were 324 patients with distant metastasis (distant metastasis + distant metastasis with local failure), with a median time of 8.1 months and a distant metastasis rate of 61.3% at 2 years. There were 194 cases of local failure (partial failure + local failure with distant metastasis) , Median time 9.1 months, 2 years local failure rate was 35.3%. The main metastatic sites were brain 42.3% (137/324), liver 32.1% (104/324), bone 31.2% (101/324), adrenal 25.6% (83/324), lung 14.2% (46/324) Skin 6.5% (21/324). The median 1, 2, 3 year survival after local failure and distant metastasis was 5.3 months, 17.5%, 10.5% and 5.3% respectively in the re-treatment group and 3.3 months, 17.4% and 4.3% in the untreated group And 2.2% respectively. The re-treatment group was better than the untreated group (X ~ 2 = 10.28, P = 0.001). The median overall survival of the re-treatment radiotherapy combined with radiotherapy was 8.6 months, which was superior to 5.1 and 4.6 months (X ~ 2 = 5.9, P = 0.053) of chemotherapy and radiotherapy alone. CONCLUSIONS: The distant metastasis is the major failure mode of SCLC. Re-treatment can prolong the survival of patients with SCLC recurrence and metastasis. In patients tolerated, re-treatment should be treated with radiotherapy and chemotherapy Mainly.