Factors associated with distant recurrence following R0 lobectomy for pN0 lung adenocarcinoma.
Factors associated with distant recurrence following R0 lobectomy for pN0 lung adenocarcinoma.
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DOI：
10.1016/j.jtcvs.2017.09.151
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发表时间：
2018-03
期刊：
影响因子：
--
通讯作者：
Jones DR
中科院分区：
文献类型：
--
作者：
Brandt WS;Bouabdallah I;Tan KS;Park BJ;Adusumilli PS;Molena D;Bains MS;Huang J;Isbell JM;Bott MJ;Jones DR
我们研究了与病理性淋巴结阴性（pN 0）肺腺癌R 0肺叶切除术后远处复发、无病生存期（DFS）和总生存期（OS）相关的因素。我们对前瞻性维护的pT 1 - 3 N 0 M0非小细胞肺癌患者数据库进行了回顾性分析。排除标准包括：异时性肺癌、分叶/不完全切除、非腺癌组织学或诱导/辅助治疗。主要结局为远处复发;次要结局为DFS/OS。通过Fine和Gray竞争风险回归分析远处复发和考克斯比例风险模型分析DFS/OS，评估变量和结局之间的相关性。在2392例pT 1 - 3 N 0 M0肺腺癌患者中，893例符合纳入标准。中位随访时间为35.0个月（范围：0.1-202个月）。13%的患者复发（n=115）; 86%（n=99）为远处复发。5年累积远处复发率为14%（95%置信区间[CI]，11%-17%）。在多变量分析中，pT 2a（HR，2.84; 95% CI，1.56-5.16，P=0.001）和pT 2b/3（HR，6.53; 95% CI，3.17-13.5; P<0.001）与远处复发相关。近期手术与远端复发减少相关（HR 0.43，95% CI 0.20-0.91，P=0.028），淋巴血管浸润（LVI）与远端复发密切相关（HR，1.62; 95% CI，1.00-2.63; P=0.05）。DFS与pT分期（P<0.001）和淋巴管浸润（P=0.004）独立相关。在接受R 0肺叶切除术的pN 0肺腺癌患者中，pT分期和淋巴血管浸润与远处复发和DFS降低相关。这些观察结果支持将这些患者纳入未来的研究佐剂靶向和免疫治疗的临床试验中。
We investigated factors associated with distant recurrence, disease-free survival (DFS), and overall survival (OS) following R0 lobectomy for pathologic node-negative (pN0) lung adenocarcinoma. We performed a retrospective analysis of a prospectively maintained database of patients with pT1-3N0M0 non-small cell lung cancer. Exclusion criteria included: metachronous lung cancer, sublobar/incomplete resection, non-adenocarcinoma histology, or induction/adjuvant therapy. The primary outcome was distant recurrence; secondary outcomes were DFS/OS. Associations between variables and outcomes were assessed by Fine and Gray competing risk regression for distant recurrence and Cox proportional hazard models for DFS/OS. Of 2392 patients identified with pT1-3N0M0 lung adenocarcinoma, 893 met the inclusion criteria. Median follow-up was 35.0 months (range, 0.1–202 months). Thirteen percent of patients developed recurrence (n=115); 86% (n=99) were distant. The 5-year cumulative incidence of distant recurrence was 14% (95% confidence interval [CI], 11%–17%). On multivariable analysis, pT2a (HR, 2.84; 95% CI 1.56–5.16, P=0.001) and pT2b/3 (HR, 6.53; 95% CI, 3.17–13.5; P<0.001) were associated with distant recurrence. Recent surgery was associated with decreased distant recurrence (HR 0.43, 95% CI 0.20–0.91, P=0.028), and lymphovascular invasion (LVI) was strongly associated with distant recurrence (HR, 1.62; 95% CI, 1.00–2.63; P=0.05). DFS was independently associated with pT stage (P<0.001) and lymphovascular invasion (P=0.004). In patients undergoing R0 lobectomy with pN0 lung adenocarcinoma, pT stage and lymphovascular invasion were associated with distant recurrence and decreased DFS. These observations support the inclusion of these patients in future clinical trials investigating adjuvant targeted and immunotherapies.
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影响因子：
2
作者：
DURRLEMAN, S;SIMON, R
通讯作者：
SIMON, R
影响因子：
4.6
作者：
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通讯作者：
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影响因子：
20.4
作者：
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影响因子：
20.4
作者：
Goldstraw, Peter;Chansky, Kari;Bolejack, Vanessa
通讯作者：
Bolejack, Vanessa
DOI：
10.1136/bmj.g5575
发表时间：
2014-10-02
期刊：
BMJ (Clinical research ed.)
影响因子：
--
作者：
Paul S;Isaacs AJ;Treasure T;Altorki NK;Sedrakyan A
通讯作者：
Sedrakyan A