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目的 探讨Ⅲ期小细胞肺癌 (smallcelllungcancer,SCLC)多学科综合治疗的疗效。方法 对 1 983年至 1 993年间 89例采用化疗或放疗 -手术 -化疗 -放疗患者的临床资料进行回顾性分析 ,并与同期单纯行化疗和 /或放疗的 6 6例Ⅲ期SCLC相比较。结果 综合治疗组的 1、3、5年生存率分别为75 .3% (6 7/ 89)、2 0 .2 % (1 8/ 89)、9.0 % (8/ 89) ,而对照组则分别为 48.5 % (32 / 6 6 )、1 2 .1 % (8/ 6 6 )、0 (P <0 .0 1 )。综合治疗组ⅢA期和ⅢB期术后 1、3、5年生存率分别为 86 .4% (5 1 / 5 9)、2 7.1 % (1 6 / 5 9)、1 3.6 %(8/ 5 9)和 5 3.3% (1 6 / 30 )、6 .7% (2 / 30 )、0 (P <0 .0 1 ) ;ⅢA期根治性与姑息性切除 5年生存率为 1 8.4%(7/ 38)和 4.8% (1 0 / 2 1 ) (P <0 .0 1 ) ;ⅢB期扩大与姑息性切除者无 5年生存者。全肺切除与肺叶切除术后 1、3、5年生存率分别为 76 .3% (2 9/ 38)、1 8.4% (7/ 38)、2 .6 % (1 / 38)和 80 .9% (38/ 4 7)、2 3.4% (1 1 / 4 7)、1 2 .8% (6 / 4 7) ,两术式 5年生存率比较有显著性差异 (P <0 .0 5 )。结论 临床TNM分期是影响生存率的决定因素 ,采取多学科综合治疗可明显提高治疗效果 ,对ⅢA期应尽量行根治性切除 ,而ⅢB期手术选择应慎重
Objective To investigate the efficacy of multi-disciplinary treatment of stage Ⅲ small cell lung cancer (SCLC). Methods The clinical data of 89 patients who underwent chemotherapy or radiotherapy - surgery - chemotherapy - radiotherapy from 1983 to 1993 were retrospectively analyzed and compared with 66 cases of stage Ⅲ SCLC treated with chemotherapy and / or radiotherapy alone in the same period. Results The 1, 3, 5-year survival rates of the combined treatment group were 75.3% (67/89), 2.02% (8/89) and 9.0% (8/89), respectively, while those in the control group 48.5% (32/6 6), 12.1% (8/6 6), 0 (P <0.01), respectively. The 1, 3, 5-year survival rates of group ⅢA and ⅢB after operation were 86.4% (51/59), 21.1% (16/59), 13.6% (8/5) The 5-year survival rate of radical and palliative resection in stage Ⅲ A was 18.4% (P <0.01) And 4.8% (10/2) (P <0.01) respectively. There was no 5-year survival in patients with stage ⅢB enlargement and palliative resection. The 1, 3, 5-year survival rates after pneumonectomy and lobectomy were 76.3% (29/38), 8.4% (7/38), 2.6% (1/38) and 80% respectively. The 5-year survival rates of the two groups were significantly different (P <0. 0%) compared with the control group (9%, 38.4%, 23.4% and 12.2% 5). Conclusion Clinical TNM staging is the determinant of survival rate, and multidisciplinary comprehensive treatment can significantly improve the therapeutic effect. Radical resection should be performed on stage ⅢA, while ⅢB surgery should be carefully chosen