Adjuvant Chemotherapy for Patients with T2N0M0 NSCLC.
Adjuvant Chemotherapy for Patients with T2N0M0 NSCLC.
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DOI：
10.1016/j.jtho.2016.05.022
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发表时间：
2016-10
期刊：
影响因子：
--
通讯作者：
Puri V
中科院分区：
文献类型：
--
作者：
Morgensztern D;Du L;Waqar SN;Patel A;Samson P;Devarakonda S;Gao F;Robinson CG;Bradley J;Baggstrom M;Masood A;Govindan R;Puri V
辅助化疗可提高完全切除的II期和III期NSCLC患者的生存率。然而，其在IB期NSCLC疾病患者中的作用仍不清楚。我们评估了辅助化疗在完全切除的T2 N 0 M0 NSCLC患者的大数据集中的作用。从国家癌症数据库中确定了2004年至2011年期间接受完全（R 0）切除术的病理分期T2 N 0 M0 NSCLC患者，并根据肿瘤大小分为4组：3.1至3.9 cm、4至4.9 cm、5至5.9 cm和6至7 cm。排除术后1个月内死亡的患者。生存曲线采用Kaplan-Meier乘积限法估计，并采用对数秩检验进行比较。在符合入选标准的25，267例患者中，有4996例（19.7%）接受了辅助化疗。与所有肿瘤大小组的观察结果相比，辅助化疗与中位生存期和5年总生存期的改善相关。在小于4 cm的T2肿瘤患者中，辅助化疗与单变量中位生存率和5年总生存率的改善相关。（101.6 vs 68.2个月[67% vs 55%]，风险比[HR] = 0.66，95%置信区间[CI]：0.61-0.72，p < 0.0001）和多变量分析（HR = 0.77，95% CI：0.70-0.83，p < 0.001）以及倾向匹配评分（101.6 vs 78.9个月[68% vs 60%]，HR = 0.75，95% CI：0.70-0.86; p < 0.0001）。在完全切除的T2 N 0 M0患者中，辅助化疗与所有肿瘤大小组的生存率改善相关。肿瘤小于4 cm患者的获益强烈表明化疗在该患者人群中的作用，并反驳了其作为辅助试验排除标准的现状。
Adjuvant chemotherapy improves survival in patients with completely resected stage II and III NSCLC. However, its role in patients with stage IB NSCLC disease remains unclear. We evaluated the role of adjuvant chemotherapy in a large data set of patients with completely resected T2N0M0 NSCLC. Patients with pathologic stage T2N0M0 NSCLC who underwent complete (R0) resection between 2004 and 2011 were identified from the National Cancer Data Base and classified into four groups based on tumor size: 3.1 to 3.9 cm, 4 to 4.9 cm, 5 to 5.9 cm, and 6 to 7 cm. Patients who died within 1 month after their operation were excluded. Survival curves were estimated by the Kaplan-Meier product-limit method and compared by log-rank test. Among the 25,267 patients who met the inclusion criteria, there were 4996 (19.7%) who received adjuvant chemotherapy. Adjuvant chemotherapy was associated with improved median and 5-year overall survival compared with observation for all tumor size groups. In patients with T2 tumors smaller than 4 cm, adjuvant chemotherapy was associated with improved median and 5-year overall survival in univariate (101.6 versus 68.2 months [67% versus 55%], hazard ratio [HR] = 0.66, 95% confidence interval [CI]: 0.61–0.72, p < 0.0001) and multivariable analysis (HR = 0.77, 95% CI: 0.70–0.83, p < 0.001) as well as propensity-matched score (101.6 versus 78.9 months [68% versus 60%], HR = 0.75, 95% CI: 0.70–0.86; p < 0.0001). In patients with completely resected T2N0M0, adjuvant chemotherapy is associated with improved survival in all tumor size groups. The benefit in patients with tumors smaller than 4 cm strongly suggests a role for chemotherapy in this patient population and counters its current status as an exclusion criteria for adjuvant trials.
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