小细胞癌是一种独特的临床病理类型，好发于肺部，但也可起源于多个肺外部位。小细胞癌是此类肿瘤的首选术语，但它们也被称作燕麦细胞癌或肉瘤、小细胞神经内分泌癌、小细胞肿瘤、间变细胞癌、微细胞瘤、储备细胞癌、未分化癌、Kulchitsky细胞癌以及伴胺前体摄取脱羧(amine precursor uptake decarboxylation, APUD)细胞分化癌。这类肿瘤被认为起源于存在于所有组织中的全能干细胞，但部分小细胞癌也可能起源于分化较好的肿瘤。
肺外小细胞癌(extrapulmonary small cell carcinoma, ESCC)极为罕见；据报道，此类肿瘤最常见于膀胱、前列腺、食管、胃、结肠和直肠、胆囊、喉、唾液腺、宫颈和皮肤。此外，小细胞癌偶尔会表现为原发灶不能确定的转移性病变，即原发灶未明的小细胞癌。
一项研究阐明了这些ESCC的不同起源；该研究纳入了120例患者，发现患者的原发部位可包括女性生殖道(26%)、胃肠道(23%)、泌尿生殖道(19%)、头颈部(16%)、原发部位不明(13%)和其他部位(4.3%)[1]。其他研究者也报道了相似的发现[2,3]。
Cancer. 2010 Mar 1;116(5):1350-7.
Survival outcomes with the use of surgery in limited-stage small cell lung cancer: should its role be re-evaluated?
Schreiber D, Rineer J, Weedon J, Vongtama D, Wortham A, Kim A, Han P, Choi K, Rotman M.
SourceDepartment of Radiation Oncology, State University of New York Downstate Medical Center, Brooklyn, NY, USA. david.schreiber@downstate.edu
Abstract
BACKGROUND: Although chemotherapy and radiation therapy currently are recommended in limited-stage small cell lung cancer (L-SCLC), several small series have reported favorable survival outcomes in patients who underwent surgical resection. The authors of this report used a US population-based database to determine survival outcomes of patients who underwent surgery.
METHODS: The Surveillance, Epidemiology, and End Results (SEER) registry was used to identify patients who were diagnosed with L-SCLC between 1988 and 2002 coded by SEER as localized disease (T1-T2Nx-N0) or regional disease (T3-T4Nx-N0). Kaplan-Meier and Cox regression analyses were used to compare overall survival (OS) for all patients.
RESULTS: In total, 14,179 patients were identified, including 863 patients who underwent surgical resection. Surgery was associated more commonly with T1/T2 disease (P < .001). Surgery was associated with improved survival for both localized disease and regional disease with improvements in median survival from 15 months to 42 months (P < .001) and from 12 months to 22 months (P < .001), respectively. Lobectomy was associated with the best outcome (P < .001). Patients with localized disease who underwent lobectomy with had a median survival of 65 months and a 5-year OS rate of 52.6%; whereas patients who had regional disease had a median survival of 25 months and a 5-year OS rate of 31.8%. On multivariate analysis, the benefit of surgery varied in a time-dependant fashion. However, the benefit of lobectomy remained across all time intervals (P = .002).
CONCLUSIONS: The use of surgery, and particularly lobectomy, in selected patients with L-SCLC was associated with improved survival outcomes. Future prospective studies should consider the role of surgery as part of the multimodality management of this disease.
PMID: 20082453 [PubMed - indexed for MEDLINE] Free full text
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