Comparative Study Of Different Treatment Modalities For Limited-stage Small Cell Lung Cancer

Objective: The aim of this retrospective study was to comparison the prognosis of surgery followed by chemotherapy versus chemoradiotherapy,and to explore the prognostic factors in the multimodality management in patients with limited stage small cell lung cancer(SCLC).Methods: Between January 2007 and November 2012,the records of 230 patients diagnosed with limited stage small cell lung cancer were in the study.All patients had cytological or histological confirmation of SCLC.There were 158 male and 72 female.The median age was 54 years old(range, 22~73years).One hundred and twenty one patients were received surgery followed by chemotherapy.Surgical procedures included lobectomy and pneumonectomy and with ipsilateral hilar and mediastinal lymphadenectomy. One hundred and nine patients were treated with chemoradiotherapy. The median radiotherapy dose was 56Gy(range 30.0-73.0Gy).The chemotherapy regimens consisted of either cisplatin and etoposide(PE) or carboplatin and etoposide(CE).The median chemotherapy cycle was 4(range 1-10 cycles). Statistics analysis was used with SPSS19.0 software, χ2 test for analysis of variance for multiple samples. Kaplan-Meier and Cox regression analyses were used to compare survival rates and local control rates. P<0.05 was defined as significant difference in statistic.Results:The deadline of the follow-up was 24 November 2014,and the follow-up rate was 96.9%.(1)For the whole group,the media survival time(MST) was 26.0 months(95%CI:21.844-30.156),and the 1-year,3-year and 5-year overall survival rates were 87.0%,38.9%,25.4%.The 1-year,3-year and 5-year overall survival rates of surgery followed by chemotherapy group and chemoradiotherapy group were91.7%,47.0%, 33.9% and 81.7%,27.1%, 23.7%, respectively(χ2=11.711,P=0.001).After stratification by clinical stage showed that Ⅰ+Ⅱ patients the 1-year,3-year and 5-year overall survival rates of surgery followed by chemotherapy group and chemoradiotherapy group were92.6%,63.2%,47.3%and76.2%,42.9%,30.6%,respectively(χ2=7.851,P=0.005), but not in stage Ⅲa patients, the 1-year, 3-year and 5-year overall survival rates of surgery followed by chemotherapy group and chemoradiotherapy group were 88.5%,26.9%,10.6% and 86.0%,25.1%, 25.1%, respectively(χ2=0.008,P=0.927).In univariate analyses,pleural effusion,tumor location,tumor stage,lymph node metastasis,clinical stage,the cycle of chemotherapy,treatment modalities were significantly associated with survival rates(P < 0.05).The multivariate analysis showed that clinical stage were independent factors of prognosis.(2)For the whole group,the 1-year,3-year and 5-year local control rates were 86.8%,69.9%,67.3%, respectively. The 1-year,3-year and 5-year local control rates of surgery followed by chemotherapy and chemoradiotherapy were 88.9%,78.6%,75.0% and 83.5%,56.8%,56.8%,respectively(χ2=5.731,P=0.017)and had a significantly different between the two groups. After stratification by clinical stage showed that stage Ⅰ+Ⅱdisease the 1-year,3-year and 5-year local control rates of surgery followed by chemotherapy,chemoradiotherapy were94%,85.8%,83.6% and 79.2%,57.3%,57.3%, respectively(χ2=6.222, P=0.013).There was no significant difference between the two group in Ⅲa patients,the 1-year,3-year and 5-year overall survival rates of surgery followed by chemotherapy group and chemoradiotherapy group were 81.6%,69.7%,61.0% 和 92.4%,71.8%, 71.8%, respectively(χ2=0.650,P=0.420).In univariate analyses,pleural effusion,tumor stage,lymph node metastasis, clinical stage,treatment modalities were significantly associated with local control rates rates(P<0.05).The multivariate analysis showed that clinical stage,lymph node metastasis were independent factors prognosis of local.Conclusion: Use of surgery followed by chemotherapy in patients with LS-SCLC of stage Ⅰ+Ⅱdisease was improved the surivial and local control, but no found great benefit for stage Ⅲa patients when was compared with chemoradiotherapy group. The clinical stage were independent factor of overall survival and local control.