局限期小细胞肺癌首程治疗后远处转移和局部失败及其再程治疗研究

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。

Analysis of Distant Metastasis and Local Failure After Initial Therapy and Salvage Treatment for Limited - stage Small - cell Lung Cancer

Background & Objective Although the small cell lung cancer was sensitive to radiotherapy and chemotherapy, its prognosis was not good with 2 - year survival rate in 18% - 32% level in patients of local stage small cell lung cancer. So it is important to analyze the failure patterns after initial treatment for improving the effect of the limited - stage small - cell lung cancer. In this paper the patterns of local failure and distant metastasis of local stage small cell lung cancer after initial treatment and the outcome of salvage treatment will be assessed. Methods From 1974 to 1996, 712 patients of limited - stage small - cell lung cancer were initially treated in our hospital. Failure patterns, prognosis after relapse, and the results of salvage treatment will be analyzed retrospectively.Results In all 712 patients, 456 developed local - regional failure and/or distant metastasis, and the median failure time and 2- year actual failure rate were 8.4 months and 75%. In 456 patients of failure, 324 developed distant metastasis alone or distant metastasis with local failure, and the median metastasis time and 2 - year actual metastasis rate were 9.1 months and 35.3%. 194 patients developed local failure alone or local failure with distant metastasis, and the median local failure time and 2 - year actual failure rate 8.1 months and 61.3%.The ratio of brain, liver, bone, adrenal gland, lung, and skin metastasis in all distant failure were 42.3% (137/324), 2.1% (104/324), 31.2% (101/324), 25.6% (83/324), 14.2% (46/324), and 6.5% (21/324) .The median survival time, 1, 2, 3 - year survival rate for patients who received salvage treatment were improved comparing with patients without salvage treatment (5.3 months, 17.5%, 10.5% and 5.3% vs 3.3 months, 17.4%, 4.3% and 2.2%, x= 10.28, P= 0.001) .The median survival time of 8.6 months in patients with salvage radiotherapy plus chemotherapy was slight better than 4.8 months with chemotherapy alone and 5.1 months with radiotherapy alone (X2 = 5.9, P= 0.053) .Conclusions Distant metastasis was the majority failure pattern in patients of local stage small cell lung cancer after initial treatment. Salvage treatment could prolong survival time for patients of relapsed local - stage small - cell lung cancer. If the conditions of patients was tolerable, chemotherapy combined with radiotherapy should be recommended for salvage treatment.