Prognositic Study Of Limited Disease Stage Small Cell Lung Cancer (SCLC) Treated With Postoperative Chemotherapy

PartⅠMultidisciplinary synthetic therapy including surgery in Limited Disease (LD) stage Small Cell Lung Cancer (SCLC)Small cell lung cancer (SCLC), accounting for 15%-20% of lung cancer, is a systemic disease which is rarely cured with surgical resection. At present, Surgery alone for SCLC is no longer used as standard therapy; standard management of SCLC has included chemotherapy or chemotherapy combined with irradiation. The role of surgery remains uncertain, However, Several studys revealed that surgery could improved outcome of Limited disease SCLC.To explore the survival outcome of LD SCLC treated with multidisciplinary therapy including surgery. Patients with LD stage SCLC treated with multidisciplinary therapy including surgery were reviewed retrospectively. 122 patients(pts) were enrolled: male 98, female 24; medium age 57; Pneumonectomy 40 pts, lobectomy 79 pts and limited resection 3 pts; R0 resection 95 pts, R1 resection 16 pts and R2 resection 11 pts. Postoperative stage: stageⅠ29 pts, stageⅡ25, stageⅢ68 pts. Two pts died within 1 month after operation, 4 pts treated with surgery alone, 2 received surgery and postoperative radiation, 3 pts received chemotherapy followed by surgery and postoperative chemotherapy (CT+S+CT), 92 pts surgery followed by postoperative chemotherapy, and 19 received surgery followed by combined chemoradiation therapy. Median survival time (MST) of overall patients is 38 months, the 1-, 3-, 5 year survival rate was 83.6%,50.0%,8.0%, respectively. According to TNM stage system, the MST of stageⅠwere not reached, for stageⅡandⅢwas 52 months, 22 months (P=-0.001), 5 year survival rate was 57.1%,43.1%,28.3%, the respectively.Our data showed that LD stage SCLC treated with multidisciplinary therapy had better survival time, and surgery may play more important role in the management of LD stage SCLC.PartⅡ Prognostic analysis of Small Cell Lung Cancer (SCLC) treated with postoperative chemotherapy111 Limited Disease stage SCLC patients treated with postoperative chemotherapy were reviewed retrospectively, prognostic analysis included clinical and pathologic factors related. Postoperative chemotherapy included platin-contained or non-platin contained standard regime. The median cycle of postoperative chemotherapy was 6(ranged from 1 to 13 cycles). The overall median survival time (MST) of SCLC treat with postoperative chemotherapy is 38 months, the 1-, 3-, 5 year survival rate was 85.6%,50.6%,38.7%, respectively. The significant prognostic factors for survival in these series of patients were early stage(P=0.006), female (P=0.042), no lymphnode metastasis(P=-0.001), no lymphovascular invasion (P=0.001), and more chemotherapy cycles(P=0.032). For 66 pts with stageⅢ, the MST of postoperative chemotherapy and postoperative chemoradiotherapy were 20 and 40 months, 5 year survival rate were 26.1% and 45.3% (P=0.071), respectively. Cox's multivariate analysis identified TNM stage (P=0.001), lymphovascular invasion(P=0.001), sex(P=0.043), lymphnode metastasis (P=0.001), and more chemotherapy cycles(P=0.033) as independent prognostic variables.For SCLC treated with postoperative chemotherapy, TNM stage system was an important prognostic factor, sex, lymphovascular invasion, lymphnode metastasis and chemotherapy cycles also affect overall survival time.PartⅢMolecular prognostic analysis of Small Cell Lung Cancer (SCLC) treated with postoperative chemotherapyThe immunohistochemical expression of VEGF/VEGFRs, PDGFR-a and Bcl-2 in limitied disease SCLC treated with postoperative chemotherapy were analyzed retrospectively. Formalin-fixed, paraffin-embedded, 3μm-thick sections were obtained from each of 94 specimens of primary lesions. The overall positivity rates for VEGF, VEGFR-1, VEGFR-2, VEGFR-3, PDGFR-a and Bcl-2 were 53.2%, 70.2%, 43%, 94.7%, 73.4% and 80.6%, respectively. No significant differences were seen in the expression rates of VEGF, VEGFR-1, VEGFR-2, VEGFR-3 and Bcl-2 according to sex, smoking history, stage, tumor location, lymphnode metastasis and lymphovascular invasion, however the expression rate of PDGFR-a was correlated with lymphnode metastasis. The expression of VEGF was significantly positive correlated with VEGFR-2 and Bcl-2, and the expression of VEGFR-1 was significantly positive correlated with VEGFR-2 and PDGFR-a. VEGF and Bcl-2 expression were associated with a poor prognosis. Patients with negative for both VEGF and Bcl-2 had better survival outcome than single or double positive. However, the expression of VEGFR-1, VEGFR-2, VEGFR-3 and PDGFR-a were not correlated with survival outcome. Cox multivariate analysis identified sex(P=0.045), stage(P=0.001), chemotherapy cycles (P=0.007) and expression of VEGF (P=0.007) as possibly independent prognostic factors.