| Objects:Small cell lung cancer(SCLC)is one of the most frustrating disease to treat because of rapid tumor doubling time and early distant metastases.Our study is to evaluate the clinical outcomes of surgery for patients with stages Ⅱ—Ⅲ small cell lung cancer and to study the influence of different clinical factors,such as sex,age,smoking,surgical procedure,T and N phases,on survival rate of patients with SCLC.Futhermore this research can provide some evidence for furture desicion about treatment of patients with small cell lung cancer.Methods:A retrospective survival analysis was performed the data derived from 36 patients with SCLC in stages Ⅱ-Ⅲ during the period of 8 years at thoracic department of the Second Hospital of Shandong University,including 12 Ⅱ phase patients and 24 Ⅲ phase patients.All the cases in this study were highly selected with pretreatment evaluation,including patients’ history,physical examination,blood count,serum chemistry,electrocardiogram,pulmonary function test,computed tomography(CT)of the chest,bone scan.No patients in this study had distant metastasis,and all patients could tolerate surgical treatment.The TNM classification was applied to all cases of SCLC.All the patients received platinum-based chemotherapy for 4-6 cycles after pulmonary resection.We divided overall patients into several groups based on their different factors,like sex,age,smoking,surgical procedure,T and N pathological phases.Kaplan-Meier analysis was used to observe the significant predictors of overall survival.Then COX analysis will be used to detect all the significant factors.Results:During the 8 years from 2008-2016,40 patients with SCLC who underwent surgical treatment at the Second Hospital of Shandong university were included in this retrospective study,including 4 patients with I p-stage,10 patients with II A p-stage,2 patients with IIB p-stage,22 patients with IIIA p-stage,2 patients with IIIB p-stage.There are 28 male patients and 12 female patients with median age 60(42～75).Lobectomy was used in 21 patients;Pnemonectomy was performed in 7 patients due to centrally located tumors;segmentectomy combined with lobectomy was performed in 4 patients because of tumors affecting more than one lobes;there were 3 people treated with sleeve lobectomy;partial resection in only one patient.All the patients underwent 4-6 cycles platinum-based chemotherapy after surgical treatment.Carbo--platin and Etoposide was used in 19 cases;Oxaliplatin and Etoposide was performed in 9 patients;4 cases recieved Carboplatin and Docetaxel,Nedaplatin and Etoposide was used in 3 patients,one case accepted Carboplatin and Vinorelbine.The 1,2,3 and 5-year survival probabilities of overall patients were 78.5%,48.8%,37.2%and 26.39/%respectively,median survival for all patients was 25 months.Then we divided overall patients into different group according to T phases.Median survival of three groups were 30(T2a).15(T2b).19(T3)mouths respectively.There was no significant discrepancy between three groups(P=0.625).We made survival curve based on different N phases.We found that median survival time was 60 months for patients in stage p-N1 and p-NO,and 19 months for stage p-N2.Outcomes of p-N2 patients were significantly worse than those without mediastinal lymph-nodes involvement(P=0.024).In order to study whether the number of lymph node involvment with same N phase has impact on long survival of patients with SCLC,we divide N2 and N1 phases patients into different groups based on number of lymph node involvment.As a result,we cannot detect significant difference between groups(P=0.229 N2 phase,P=0.351 N1 phase).Then the study showed significant discrepancy between different surgical procedures(P=0.005).Other clinical factors,like sex and age,had no influence on the long survival rate of SCLC patients(sex P value=0.574,age P value=0.334).Finally,we used Kaplan-Meier to analyse patients with different smoking statues.Patients who did not smoke had better survival rate than thos who have smoked for a long time(P=0.006).Then we analysed significant factors-N phase,surgical procedure and smoking statue-by COX.And the results suggested that relative risks of N phase,surgical procedure and smoking statue were 2.526,1.263,1.365 respectively.Conclusions:1.P-N stage,surgical procedure and smoking statue have significant influences on prognosis of SCLC patients;2.Our research indicated that surgical treatment can performe for Ⅱ stage patients;3.more random prospective analysis from different centers should be conducted to provide more meaningful results about benefits of surgery for patients with SCLC. |
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