临床I期小细胞肺癌的治疗回顾：外科切除的日益重要的作用
Review of Management of Clinical Stage I Small Cell Lung Cancer: The Rising Role of Surgical Resection.
摘要(中文译文)
小细胞肺癌（SCLC）是一种侵袭性恶性肿瘤，传统上被视为全身性疾病进行治疗，手术基本被排除在标准管理之外。然而，一小部分患者表现为临床I期疾病（T1-2N0M0）。随着影像学、分期和全身治疗的进步，局部治疗值得考虑。我们进行了一项聚焦于临床I期SCLC的叙述性文献综述，优先纳入涉及流行病学、肿瘤生物学、诊断检查、分期、治疗方法和监测的研究。重点放在当前指南推荐以及与手术和非手术局部治疗相关的当代回顾性数据上。临床I期SCLC较为罕见，且在接受完整诊断评估后常被上调分期，这凸显了在考虑手术时进行彻底分期及对淋巴结阴性病变进行病理确认的必要性。即使在推测为局部病变的情况下，经过规范的分期检查，远处转移也常常显而易见。回顾性分析提示，经过仔细筛选的I期患者接受手术切除（尤其是肺叶切除术）作为包括辅助全身治疗在内的多模式治疗的一部分，具有实现疾病长期控制的潜力。对于不适合手术的患者，立体定向体部放疗联合全身治疗是合理的替代方案。预防性颅脑照射的作用以及I期疾病的最佳监测策略仍是不确定的领域。临床I期SCLC影响一小群独特的患者，传统治疗策略可能需要重新考量。综合来看，回顾性证据提示经过仔细筛选的患者接受手术具有生存获益，尽管缺乏前瞻性验证。对于分期适当、可手术的患者，手术值得考虑，同时应认识到现有数据的局限性以及在这一罕见人群中进一步研究的必要性。
Abstract
Small cell lung cancer (SCLC) is an aggressive malignancy that has traditionally been treated as a systemic disease, with surgery largely excluded from standard management. A small subset of patients, however, present with clinical Stage I disease (T1-2N0M0). With improvements in imaging, staging, and systemic therapy, local therapy warrants consideration. We performed a narrative review of the literature focused on clinical Stage I SCLC, prioritizing studies addressing epidemiology, tumor biology, diagnostic workup, staging, treatment approaches, and surveillance. Emphasis was placed on current guideline recommendations and contemporary retrospective data relevant to surgical and non-surgical local therapies. Clinical Stage I SCLC is rare and is frequently upstaged with complete diagnostic evaluation, highlighting the need for thorough staging and pathologic confirmation of node-negative disease when surgery is considered. Even in presumed local disease, distant metastases are many times evident with a proper staging workup. Retrospective analyses suggest potential for long-term control of disease in carefully selected Stage I patients treated with surgical resection, particularly lobectomy, as part of multimodality therapy that includes adjuvant systemic therapy. For patients who are not surgical candidates, stereotactic body radiation therapy combined with systemic therapy is a reasonable alternative. The role of prophylactic cranial irradiation and optimal surveillance strategies in Stage I disease remain areas of uncertainty. Clinical Stage I SCLC affects a small and unique group of patients where traditional treatment strategies may need to be reconsidered. Taken together, retrospective evidence suggests a survival benefit for surgery in carefully selected patients, although prospective validation is lacking. Surgery warrants consideration in appropriately staged, operable patients, while recognizing the limitations of existing data and the need for further study in this rare population.
如何引用
AMA
Gabriella R Rasmussen, Eric Klipsch, Kathryn E Engelhardt. Review of Management of Clinical Stage I Small Cell Lung Cancer: The Rising Role of Surgical Resection.. Cancers. 2026; doi:10.3390/cancers18111781.
APA
Gabriella R Rasmussen, Eric Klipsch, Kathryn E Engelhardt (2026). Review of Management of Clinical Stage I Small Cell Lung Cancer: The Rising Role of Surgical Resection.. Cancers. https://doi.org/10.3390/cancers18111781
GB/T 7714
Gabriella R Rasmussen, Eric Klipsch, Kathryn E Engelhardt. Review of Management of Clinical Stage I Small Cell Lung Cancer: The Rising Role of Surgical Resection.[J]. Cancers, 2026 doi:10.3390/cancers18111781.
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