Prognosis Of Small Cell Lung Cancer Patients With Surgical Treatment And Analyses Of Its Influencing Factors

Objectives: This paper aims to retrospectively analyze and summarizethe surgical treatment efficacy of small cell lung cancer (SCLC) patients andthe related prognostic factors.Methods: The subjects of this study are233SCLC patients who havereceived surgical treatment in Cardiothoracic Surgery of the Fourth Hospitalof Hebei Medical University from September2003to June2008. This groupof patients have been pathologically confirmed and possess complete clinicalmedical records. Among these patients, there are178males (76.4%) and55females (23.6%), and the ratio of males to females is3.2:1. The patients are21-76years old with a median age of54years old. Postoperative pathologicTNM staging can be divided into Stage I (51cases,21.9%), Stage II (69cases,29.6%), Stage III (109cases,46.8%) and Stage IV (4cases,1.7%). A numberof clinical medical records about these patients are arranged, which includeage, gender, smoking history, drinking history, family history, pathologicTNM staging (AJCC2010TNM staging of small cell lung cancer), lymphnode dissection and metastasis, tumor location, surgical approach andpostoperative treatment. In terms of the above factors, univariate andmultivariate analyses are conducted and the prognosis and its influencingfactors are evaluated. This study adopts SPSS19.0for statistical analysis,Kaplan-Meier for survival analysis, Log-rank for non-parametric test, andCOX proportional hazard model for multivariate survival analysis.Results:(1) Among the233cases, the follow-up rate is95.8%and themedian survival time is30.27months with the survival rates in the first, thirdand fifth year80.30%,45.84%and34.73%, respectively; postoperativeprogression-free median survival time is22.9months with theprogression-free survival rates in the first, third and fifth year66.9%,38.1% and31.4%, respectively. There are30cases of postoperative brain metastases.Among these patients, one has died of acute myocardial infarction (irrelevantto the disease studied in this paper and its treatment) and eleven have died ofpostoperative complications. Intraoperative pathology showes that a total of1839lymph nodes have been removed among which there are508metastaticlymph nodes with a lymph node metastasis (LNR) of27.6%.91cases do nothave metastatic lymph nodes (39.1%) and142cases have metastatic lymphnodes (60.9%);98patients (42.1%) have1-4metastatic lymph nodes and44patients (18.9%) have more than4metastatic lymph nodes. The numbers ofmetastatic lymph nodes in Group7(subcarinal lymph nodes), Group10(hiiarlymph nodes) and Group2(tracheal lymph nodes) are137(26.6%),121(23.8%) and90(17.7%), respectively.71cases have received the surgeryalone;127cases have received both surgery and chemotherapy;35cases havereceived the surgery, chemotherapy and radiotherapy.144cases havecomplete resection and89cases have incomplete resection; among all thecases, there are single lobectomy (94cases), pneumonectomy (69cases), jointlobectomy (39cases), multi-visceral resection and vascular resection (21cases), wedge resection (6cases), segment resection of lung (2cases) andsimple thoracotomy (2cases);55cases have received preoperativechemotherapy and178cases have not received preoperative chemotherapy.132cases have received postoperative chemotherapy and101cases have notreceived postoperative chemotherapy, chemotherapy regimens all includeplatinum;35cases have received postoperative radiotherapy and198caseshave not received postoperative radiotherapy.(2) univariate analysis: femaleprognosis is better than that of males (P=0.013); if the smoking index isgreater than600, the prognosis is poor (P=0.029);5-year survival rate in StageI, Stage II, Stage III and Stage IV are66.6%,35.6%,18.8%and5.7%respectively; the later the staging is, the poorer the prognosis is (P=0.000); theperipheral tumor has a better prognosis (P=0.024); in terms of surgicalapproach, the prognosis of single lobectomy group is significantly better thanthose of joint lobectomy group (P=0.015), pneumonectomy group (P=0.002) and multi-visceral resection and vascular resection group (P=0.014); bronchialstump-positive patients have poorer prognosis (P=0.013); survival prognosisin preoperative chemotherapy group is poorer (P=0.004); prognosis inpostoperative chemotherapy group is good (P=0.019); patients with lymphnode metastasis have poorer prognosis (P=0.000); patients with more than4lymph nodes have poorer prognosis (P=0.011); patients with postoperativebrain metastasis have poorer prognosis (P=0.001). In terms of various agegroups (P=0.986), family histories of cancer (P=0.376), whether to becomplete resection (P=0.321), whether to have received PCI (P=0.534),whether to have received radiotherapy (P=0.098) and therapeutic methods(P=0.421), the differences in their survival rates are not statistically significant.(3) COX multivariate proportional hazards model shows that, COXmultivariate regression model (Backward Wald method) is used to analyze the12prognostic factors that are founded in the univariate analysis to have greatinfluence on prognosis). Finally,5prognostic factors enter Cox regressionmodel equation: gender, preoperative chemotherapy, pathologic TNM staging,postoperative chemotherapy and brain metastases.Conclusions:1Age and history of drinking are not important factors thatinfluence the prognosis of SCLC patients with surgical treatment.2Gender, smoking index, surgical approach (single lobectomy,pneumonectomy, etc.), whether to have lymph node metastasis, pathologicTNM staging, postoperative chemotherapy, bronchial stump or brainmetastases are the main factors that affect the prognosis of SCLC patientswith surgical treatment.3Gender, pathologic TNM staging, postoperative chemotherapy, brainmetastasis are independent risk factors that influence the prognosis of SCLCpatients with surgical treatment.4Male patients, patients who are heavy smokers (smoking index＞600),patients with later postoperative pathologic staging, and patients with brainmetastasis have poorer prognosis. Postoperative chemotherapy can increasethe patients survival time. 5Single lobectomy, together with systematic lymphadenectomy, canimprove the prognosis of stageⅠ、stageⅡand stage Ⅲ SCLC patients inTNM staging. Special attention should be paid to patients who have receivedpneumonectomy or joint lobectomy.6Lymph node dissection in Group7is of great significance to thesurgical treatment for right lung lobe SCLC patients. If the number of positivelymph nodes is more than4, it will seriously affect the prognosis of patients.7Surgery supplemented by chemotherapy or radiotherapy will bringgood results to stageⅠ、stageⅡand stage Ⅲ SCLC patients.8The influence of complete resection on prognosis still needs to befurther discussed.9The influence of preoperative chemotherapy on prognosis remainscontroversial.