Surgery for combined type small cell lung carcinoma
a Department of Pulmonology, b Department of Pathology, c Department of Thoracic Surgery, d St Antonius Hospital, P O Box 2500, 3430 EM Nieuwegein, The Netherlands
Correspondence to: Dr J M M van den Bosch.
Received 30 June 1997; Returned to authors 18 December 1997; Revised version received 5 January 1998; Accepted for publication 7 January 1998
BACKGROUND
Combined type small cell lung cancer
(SCLC) has been reported to occur in, at most, 1% of all cases of
SCLC. These tumours consist of SCLC with a component of squamous cell
carcinoma and/or adenocarcinoma. The survival of patients with combined
and pure SCLC after surgical resection was assessed.
METHODSFrom 1977 to 1994 2115 patients with
bronchogenic carcinoma underwent pulmonary resection. From this group
26 patients (1.2%) were diagnosed as having combined SCLC and 74 patients (3.5%) as having pure SCLC.
RESULTSFrom the 26 patients with combined SCLC
(mean age 66.4 years) three were classified as pT1N0M0, eight as
pT2N0M0, four as postoperative stage II, and 11 as postoperative stage
III. Histological examination showed a component of squamous cell
carcinoma in 21 patients. There were 18 (69%) lobectomies, seven
(27%) pneumonectomies, and one (4%) segmentectomy. In all patients
surgery was thought to be curative. Overall hospital mortality was 4%
(n = 1). Cumulative five year survival was 31% for all hospital
survivors with combined SCLC postoperative stage I, 50% for those with
pT1N0M0, and 25% for those with pT2N0M0 disease. No patients with
postoperative stage II and III disease survived for five years. In the
74 patients with pure SCLC hospital mortality was 3% (n = 2);
cumulative five year survival was 39% in patients with postoperative
stage I disease, 46% for those with pT1N0M0 and 35% for those with
pT2N0M0. When compared with pure SCLC, no significant differences in
five year survival were evident in patients with
postoperative stage I disease.
CONCLUSIONSSurgical resection in patients
with combined SCLC postoperative stage I yields a cumulative five year
survival of 31% while for those with stage II and III disease there
were no survivors at five years. In patients with stage I combined or
pure SCLC surgery can offer a long term disease free interval or may
even be curative.
© 1998 by Thorax
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