Lung Adjuvant Cisplatin Evaluation: A pooled analysis by the LACE collaborative group
Lung Adjuvant Cisplatin Evaluation: A pooled analysis by the LACE collaborative group
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DOI：
10.1200/jco.2007.13.9030
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发表时间：
2008-07-20
影响因子：
45.3
通讯作者：
Le Chevalier, Thierry
中科院分区：
文献类型：
--
作者：
Pignon, Jean-Pierre;Tribodet, Helene;Le Chevalier, Thierry
目的：近期的一些临床试验表明，非小细胞肺癌（NSCLC）患者术后接受以顺铂为基础的化疗可显著提高总生存期（OS）。肺辅助顺铂评估的目的是确定治疗方案与更高的收益或群体的患者谁特别受益于术后chemotherapy.Patients和MethodsIndividual患者的数据收集和汇总从五个最大的试验（4,584例患者）的顺铂为基础的化疗完全切除的患者进行后，1995年非小细胞肺癌荟萃分析。患者亚组或治疗类型和化疗对OS的影响之间的相互作用进行了分析，使用风险比（HRs）和对数秩检验分层的trial.ResultsWith的中位随访时间为5.2年，死亡的总体风险比为0.89（95%CI，0.82至0.96; P=.005），对应于5年的绝对受益5.4%化疗。各试验间化疗效果无异质性。效益因阶段而异（趋势检验，P= 0.04; IA期HR = 1.40; 95%CI，0.95 - 2.06; IB期HR = 0.93; 95%CI，0.78 - 1.10; II期HR = 0.83; 95%CI，0.73 - 0.95; III期HR = 0.83; 95% CI，0.72至0.94）。化疗效果与相关药物无显著差异（相互作用检验，P= 0.11），包括长春瑞滨（HR = 0.80; 95% CI，0.70 - 0.91）、依托泊苷或长春花生物碱（HR = 0.92; 95% CI，0.80 - 1.07）或其他（HR = 0.97; 95% CI，0.84 - 1.13）。体能状态越好的患者化疗效果越好。化疗效果与性别、年龄、组织学、手术类型、计划放疗或计划总剂量cisplatin.ConclusionPostoperative cisplatin为基础的化疗显著提高了NSCLC患者的生存率。
PurposeSeveral recent trials have shown a significant overall survival (OS) benefit from postoperative cisplatin-based chemotherapy in patients with non-small-cell lung cancer (NSCLC). The aim of the Lung Adjuvant Cisplatin Evaluation was to identify treatment options associated with a higher benefit or groups of patients who particularly benefit from postoperative chemotherapy.Patients and MethodsIndividual patient data were collected and pooled from the five largest trials (4,584 patients) of cisplatin-based chemotherapy in completely resected patients that were conducted after the 1995 NSCLC meta-analysis. The interactions between patient subgroups or treatment types and chemotherapy effect on OS were analyzed using hazard ratios (HRs) and log-rank tests stratified by trial.ResultsWith a median follow-up time of 5.2 years, the overall HR of death was 0.89 (95% CI, 0.82 to 0.96; P=.005), corresponding to a 5-year absolute benefit of 5.4% from chemotherapy. There was no heterogeneity of chemotherapy effect among trials. The benefit varied with stage (test for trend, P=.04; HR for stage IA = 1.40; 95% CI, 0.95 to 2.06; HR for stage IB = 0.93; 95% CI, 0.78 to 1.10; HR for stage II = 0.83; 95% CI, 0.73 to 0.95; and HR for stage III = 0.83; 95% CI, 0.72 to 0.94). The effect of chemotherapy did not vary significantly (test for interaction, P=.11) with the associated drugs, including vinorelbine (HR = 0.80; 95% CI, 0.70 to 0.91), etoposide or vinca alkaloid (HR = 0.92; 95% CI, 0.80 to 1.07), or other (HR = 0.97; 95% CI, 0.84 to 1.13). Chemotherapy effect was higher in patients with better performance status. There was no interaction between chemotherapy effect and sex, age, histology, type of surgery, planned radiotherapy, or planned total dose of cisplatin.ConclusionPostoperative cisplatin-based chemotherapy significantly improves survival in patients with NSCLC.