| Objectives:The aim of this study was to evaluate the effect of combined modality treatment for small cell lung cancer (SCLC) patients and analyze the prognostic factors of survival.Methods:We retrospectively analyzed 187 patients was diagnosed by histopathological proved with SCLC from January 2006 to January 2009 in our Hospital. There were 143 male and 44 female, age range from 19 to 78 years with a median age 55 years old, and 166 cases were the limited stage and 21 cases extensive stage. Multimodality treatment including 132 cases received radiotherapy plus chemotherapy (R+C),32 casets received surgery plus chemotherapy (S+C), and 13 cases received surgery plus radiotherapy plus chemotherapy (S+R+C). The number of patients who received surgery alone (S), Radiotherapy alone (R) or chemotherapy alone (C) were 3 cases,5 cases and 2 cases, respectively. We analyzed the clinical data of each patient such as sex, age, symptoms of first diagnosis, clinical stage and treatment modality and evaluated the survival and prognosis influencing factors. SPSS 11.5 software package was used to finish statistical analysis. The survival rate was calculated by Kaplan-Meier method, the significantly different by Log-rank test and COX proportional hazards model for multivariate analysis.Results:The patients were followed up to January 10,2011 and follow-up rate was 100%. The 1,2 and 3-year overall survival rates were 72.08%,42.22% and 33.04%, respectively. The mean survival time and median survival time were 21.5 months and 19 months. (2) The 1,2,3-year survival rates were 87.50%,68.75%,61.38% in S+C group and 70.27%, 36.12%,25.96% in R+C group, and 92.31%,60.58%,60.58%. in S+R+C group, respectively. (3) The 1,2,3-year survival rate was higher in S+C group than those in R+C group, and had a significantly different between the two groups. But there was no statistical difference between groups of S+R+C and S+C. Although a rising trend was observed of 1,2,3-year survival rate in S+R+C group compared to R+C group, there was no significant difference between the two groups. (4) According to the number of chemotherapy cycles, the survival rates were significant higher in 4 to 6 cycles group and> 6 cycles group, than those patients<4 cycles, while no significant difference was observed with the survival rates between the two former groups. (5) According to the radiation dose, patients were divided into two groups≥50Gy and <50Gy. The 1,2,3-year survival rates were 74.59%,39.93%,29.93% and 48.54%,23.60%,18.88%, respectively. Survival rates were significant higher in≥50Gy group than those<50Gy group. (6) The 1,2,3 year survival rates were 77.46%,47.62%,36.40% and 61.29%,31.47%,26.79% with patients age< 60 years and≥60 years, and there was a statistical significance between the two groups. (7) The 1,2,3 year survival rate were 73.03%,44.00%, and 34.27% for without hoarseness, which was significantly higher than that of patients with hoarseness (58.33%,16.67%,16.67%). The survival rate was clearly lower with distant metastasis at first visit than that none distant metastasis. Infiltration of operation stump also affected the survival rate. It was significant higher with distant metastasis at first visit than that of with positive infiltration. Univariate analysis showed that lymph node metastasis in mediatinum and treatment modalities were the factors related to local recurrence. While hoarseness, tumor stage and distant metastasis were the factors of occurring distance metastasis after, treatment Multivariate analysis showed that distant metastasis and number of chemotherapy cycles were independent prognostic factors. The degree of bone marrow suppression also affected survival rate. Patients without bone marrow suppression, with I myelosuppression or II myelosuppression had a better survival rates than those patients with III myelosuppression, but the survival rates were not significant difference among the first three groups. As to the follow up date 124 cases (66.31%) died, of which 120 cases (96.77%) died of tumor-related causes and 4 cases (3.23%) died of non-tumor factors.20 cases (16.67%) died of local recurrence,85 cases (70.83%) died of distant metastasis and 15 patients (12.50%) died of local recurrence and distant metastasis.Conclusions:The combined modality treatment is still the standard treatment for SCLC, and the addition of surgery can significantly improve the survival, but the timing and indications for surgery need further study. Chemotherapy cycles and treatment modalities were the independent prognostic factors of SCLC. Mediastinal lymph node metastasis and distant metastasis will be of significant impact on patient survival.
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