Predictors for Locoregional Recurrence for Clinical Stage III-N2 Non-small Cell Lung Cancer with Nodal Downstaging After Induction Chemotherapy and Surgery
Predictors for Locoregional Recurrence for Clinical Stage III-N2 Non-small Cell Lung Cancer with Nodal Downstaging After Induction Chemotherapy and Surgery
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DOI：
10.1245/s10434-012-2800-x
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发表时间：
2013-06-01
影响因子：
3.7
通讯作者：
Lin, Steven H.
中科院分区：
文献类型：
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作者：
Amini, Arya;Lou, Feiran;Lin, Steven H.
III-N2期NSCLC化疗后的病理学降级是一个众所周知的积极预后指标。然而，局部复发（LRR）在这些patients.Between 1998年和2008年，153例临床或病理分期III-N2非小细胞肺癌患者在美国的两个癌症中心接受诱导化疗和手术治疗的预测因素在很大程度上是未知的。所有患者均为病理性N 0 -1疾病，无患者接受术后放疗。LRR定义为手术部位、淋巴结（1-14级，包括锁骨上）或两者复发。中位随访时间为39.3个月。治疗前N2状态经病理学（18.2%）或PET/CT（81.8%）证实。总体而言，5年LRR率为30.8%（n = 38），LRR是51%的第一失效部位（22/+99877943）。LRR患者与无LRR患者相比，5年总生存率分别为21%和60.1%（p < 0.001）。使用多变量分析，LRR的显著预测因素为手术时pN 1疾病（p < 0.001，HR 3.43，95%CI 1.80-6.56）和鳞状组织学趋势（p = 0.072，HR 1.93，95%CI 0.94-3.98）。pN 1与pN 0疾病的5年LRR率分别为62%和20%。单站与多站N2疾病（p = 0.291）或初始分期技术（p = 0.306）均不是LRR的预测因子。N1状态也预示着更高的远处复发率（p = 0.021，HR 1.91，95% CI 1.1-3.3），但仅存在生存期较差的趋势（p = 0.123，HR 1.48，95%CI 0.9-2.44）在诱导化疗和淋巴结降级后，切除的III-N2期NSCLC患者的LRR仍然很高，特别是在持续性N1疾病患者中。
Pathologic downstaging following chemotherapy for stage III-N2 NSCLC is a well-known positive prognostic indicator. However, the predictive factors for locoregional recurrence (LRR) in these patients are largely unknown.Between 1998 and 2008, 153 patients with clinically or pathologically staged III-N2 NSCLC from two cancer centers in the United States were treated with induction chemotherapy and surgery. All had pathologic N0-1 disease, and none received postoperative radiotherapy. LRR were defined as recurrence at the surgical site, lymph nodes (levels 1-14 including supraclavicular), or both.Median follow-up was 39.3 months. Pretreatment N2 status was confirmed pathologically (18.2 %) or by PET/CT (81.8 %). Overall, the 5-year LRR rate was 30.8 % (n = 38), with LRR being the first site of failure in 51 % (22/+99877943). Five-year overall survival for patients with LRR compared with those without was 21 versus 60.1 % (p < 0.001). Using multivariate analysis, significant predictors for LRR were pN1 disease at time of surgery (p < 0.001, HR 3.43, 95 % CI 1.80-6.56) and a trend for squamous histology (p = 0.072, HR 1.93, 95 % CI 0.94-3.98). Five-year LRR rate for pN1 versus pN0 disease was 62 versus 20 %. Neither single versus multistation N2 disease (p = 0.291) nor initial staging technique (p = 0.306) were predictors for LRR. N1 status also was predictive for higher distant recurrence (p = 0.021, HR 1.91, 95 % CI 1.1-3.3) but only trended for poorer survival (p = 0.123, HR 1.48, 95 % CI 0.9-2.44).LRR remains high in resected stage III-N2 NSCLC patients after induction chemotherapy and nodal downstaging, particularly in patients with persistent N1 disease.