Adjuvant Chemotherapy Candidates in Stage I Lung Adenocarcinomas Following Complete Lobectomy
Adjuvant Chemotherapy Candidates in Stage I Lung Adenocarcinomas Following Complete Lobectomy
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DOI：
10.1245/s10434-019-07366-z
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发表时间：
2019-08-01
影响因子：
3.7
通讯作者：
Han, Baohui
中科院分区：
文献类型：
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作者：
Qian, Jie;Xu, Jianlin;Han, Baohui
背景本研究旨在基于完全肺叶切除的I期肺腺癌（LAD）患者的复发风险评分模型探索辅助化疗（ACT）候选者。方法对2008年至2014年在上海胸科医院接受完全肺叶切除治疗LAD的4606例患者（非ACT组：n=3514；ACT组：n=1092）进行回顾性研究。使用 Cox 比例风险回归在非 ACT 组中开发了预测无复发生存期 (RFS) 的方法。在整个队列中计算基于列线图的风险评分。按风险评分分层比较非 ACT 组和 ACT 组之间 RFS 的差异。使用X-tile软件确定评分截止点。结果6个独立的预测因素，包括年龄、性别、肿瘤大小、病理亚型、内脏胸膜侵犯(VPI)和淋巴血管侵犯(LVI)与RFS相关。列线图比第 8 次 TNM 分期更准确地预测 RFS {C 指数：0.784 [95% 置信区间 (CI) 0.756-0.812] vs. 0.719 (95% CI 0.689-0.749)，p=0.0017}。在低、中、高风险组中观察到显着的 RFS 差异（p= 245 占 I 期患者的 2.6%）。结论列线图为肺叶切除术后 I 期 LAD 的 RFS 提供了个体预测。高风险患者（分数 >= 245）可能会从术后 ACT 中受益。
BackgroundThis study aimed to explore adjuvant chemotherapy (ACT) candidates based on a recurrence risk-scoring model in completely lobectomized stage I patients with lung adenocarcinoma (LAD).MethodsA retrospective study was performed on 4606 patients (non-ACT group: n=3514; ACT group: n=1092) who underwent complete lobectomy for LAD at Shanghai Chest Hospital from 2008 to 2014. The nomogram predicting recurrence-free survival (RFS) was developed in the non-ACT group using Cox proportional hazards regression. The nomogram-based risk score was calculated in the entire cohort. Differences of RFS between the non-ACT and ACT groups were compared as stratified by the risk score. The score cut-off points were determined using the X-tile software.ResultsSix independent predictors, including age, sex, tumor size, pathological subtype, visceral pleural invasion (VPI), and lymphovascular invasion (LVI) were associated with RFS. The nomogram more accurately predicted RFS than the 8th TNM staging {C-index: 0.784 [95% confidence interval (CI) 0.756-0.812] vs. 0.719 (95% CI 0.689-0.749), p=0.0017}. A significant RFS difference was observed among the low-, intermediate- and high-risk groups (p= 245 constituted 2.6% of stage I patients.ConclusionsThe nomogram provided an individual prediction of RFS for stage I LAD following lobectomy. High-risk patients (score >= 245) may benefit from postoperative ACT.