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Comparison of clinical prognosis of chemo-radiotherapy and surgical treatment for patients with limited stage small cell lung cancer after matching
Chen Mengyuan, Hu Xiao, Qi Xiaofang, Xu Yujin, Dong Baiqiang, Chen Yamei, Chen Ming
Institute of Cancer and Basic Medicine (ICBM), Chinese Academy of Sciences/Department of Radiation Oncology, Cancer Hospital of the University of Chinese Academy of Sciences/Department of Radiation Oncology, Zhejiang Cancer Hospital, Hangzhou, 310022
AbstractObjective To compare the overall survival (OS), progression-free survival (PFS) and brain metastasis free survival (BMFS) between the chemo-radiotherapy and surgical treatment for patients with limited stage small cell lung cancer (LS-SCLC). Methods Clinical data of 69 patients diagnosed with LS-SCLC undergoing surgery in Zhejiang Cancer Hospital between 2000 and 2016 were collected. According to T,N stage, treatment duration, age, gender and whether or not prophylactic cranial irradiation (PCI), 69 patients of 503 LS-SCLC patients who underwent standard radiochemotherapy were assigned into the radiochemotherapy group by using the pair-matched case-control method. Results Among 138 patients, 69 cases were allocated into the surgery group (24 cases of stage Ⅰ, 14 cases of stage Ⅱ and 31 cases of stage Ⅲ) and 69 cases in the radiochemotherapy group (24 cases of stage Ⅰ, 14 cases of stage Ⅱ and 31 cases of stage Ⅲ). The median OS time was 37.1 months (95%CI:24.1-50.2 months) in surgery group and 45.0 months (95%CI:15.8-74.2 months) in the radiochemotherapy group. The 2-and 5-year OS rates were 60% and 45% in the surgery group, and 64% and 45% in the radiochemotherapy group (P=0.846). The median PFS time was 27.1 months (95%CI:0.00-60.3 months) in the surgery group and 36.2 months (95%CI:20.9-51.4 months) in the radiochemotherapy group. The 2-and 5-year PFS rates were 52%,and 38% in the surgery group, and 56% and 40% in the chemo-radiotherapy group (P=0.610). The 2-and 5-year BMFS rates were 81% and 76% in the surgery group, and 84% and 80% in the radiochemotherapy group (P=0.774). The 5-year OS rate (62% vs. 40%,P=0.038) and 5-year PFS rate (80% vs.40%,P=0.048) for patients with stage Ⅰ LS-SCLC in the surgery group were significantly higher than those in the radiochemotherapy group. However, the 5-year BMFS rate in patients with stage Ⅰ LS-SCLC did not significantly differ between two groups (92% vs.95%, P=0.816). The 5-year OS rate (41% vs.51%, P=0.946), 5-year PFS rate (65% vs.42%, P=0.280) and 5-year BMFS rate (75% vs.78%, P=0.720) for stage Ⅱ SCLC did not significantly differ between two groups. As for stage Ⅲ SCLC patients, the OS rate (25% vs.48%, P=0.220), 5-year PFS rate (28% vs.36%, P=0.333) and 5-year BMFS rate (76% vs. 74%, P=0.84) did not significantly differ between two groups. Conclusions Surgical treatment can bring survival benefits to patients with stage Ⅰ LS-SCLC. The survival prognosis of stage Ⅱ patients is equivalent between two groups. Patients with stage Ⅲ LS-SCLC receiving radiochemotherapy obtain better survival trend compared with those undergoing surgery. The conclusion remains to be validated by studies with larger sample size or prospective investigations.
Fund:National Natural Science Foundation of China (81402540,81401911,81672972)|National Health and Family Planning Commission Scientific Research Fund-Zhejiang Province Medical and Health Major Science and Technology Program (Provincial Joint Construction Plan) Project (WKJ-ZJ-1701)
Chen Mengyuan,Hu Xiao,Qi Xiaofang et al. Comparison of clinical prognosis of chemo-radiotherapy and surgical treatment for patients with limited stage small cell lung cancer after matching[J]. Chinese Journal of Radiation Oncology, 2019, 28(11): 821-825.
Chen Mengyuan,Hu Xiao,Qi Xiaofang et al. Comparison of clinical prognosis of chemo-radiotherapy and surgical treatment for patients with limited stage small cell lung cancer after matching[J]. Chinese Journal of Radiation Oncology, 2019, 28(11): 821-825.
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