Adjuvant Chemotherapy for High-risk Pathologic Stage I Non-Small Cell Lung Cancer
Adjuvant Chemotherapy for High-risk Pathologic Stage I Non-Small Cell Lung Cancer
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DOI：
10.1016/j.athoracsur.2021.04.108
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发表时间：
2022-04-19
影响因子：
4.6
通讯作者：
Okada, Morihito
中科院分区：
文献类型：
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作者：
Tsutani, Yasuhiro;Imai, Kentaro;Okada, Morihito
背景：本研究旨在探讨辅助化疗治疗复发风险高的病理期非小细胞肺癌（NSCLC）的疗效。方法：前瞻性收集1278例按照第八版分期指南行肺叶切除术的病理I期NSCLC患者资料进行回顾性分析。使用多变量Cox无复发生存（RFS）比例风险模型确定与复发高风险相关的因素。对接受辅助化疗和未接受辅助化疗的患者的生存率进行比较。结果：在多变量分析中，年龄（70岁）、侵入成分大小（> ~ 2cm）、内脏胸膜侵入、淋巴侵入和血管侵入被确定为RFS的独立因素。在有病化性T1c、T2a或淋巴血管浸润等复发高危因素的患者（高危组，n = 641）中，辅助化疗的RFS和总生存期（n = 222, 5年RFS， 81.4%， 5年总生存期，92.7%）明显长于未接受辅助化疗的患者（n = 418, 5年RFS， 73.8%, P = 0.023, 5年总生存期，81.7%,P < 0.0001）。无复发高危因素的患者（低危组，n = 637），接受辅助化疗组（n = 83, 5年RFS， 98.1%）与未接受辅助化疗组（n = 554, 5年RFS， 95.7%, P = 0.30）的RFS差异无统计学意义。结论：辅助化疗可提高具有复发高风险因素（如病理性T1c或T2a或淋巴血管浸润）的病理性I期NSCLC患者的生存率。(C) 2022年由胸外科学会提供
BACKGROUND: This study aimed to investigate the efficacy of adjuvant chemotherapy for pathologic stage I non-small cell lung cancer (NSCLC) with high risk for recurrence.METHODS: Prospectively collected data from 1278 patients with pathologic stage I NSCLC according to eighth edition staging guidelines who were undergoing lobectomy were retrospectively analyzed. Factors associated with high risk for recurrence were determined using the multivariable Cox proportional hazards model for recurrence-free survival (RFS). Survival was compared between patients who received adjuvant chemotherapy and those who did not.RESULTS: In multivariable analysis, age (=70 years), invasive component size (>2 cm), visceral pleural invasion, lymphatic invasion, and vascular invasion were identified as independent factors for RFS. In patients with high-risk factors for recurrence such as pathologic T1c or T2a or lymphovascular invasion (high-risk group; n = 641), adjuvant chemotherapy resulted in significantly longer RFS and overall survival (n = 222; 5-year RFS, 81.4%; 5-year overall survival, 92.7%) than in patients who did not receive adjuvant chemotherapy (n = 418; 5-year RFS, 73.8%; P = .023; 5-year overall survival, 81.7%; P < .0001). In patients without any high-risk factors for recurrence (low-risk group; n = 637), RFS was not significantly different between those who received adjuvant chemotherapy (n = 83; 5-yeat RFS, 98.1%) and those who did not (n = 554; 5-year RFS, 95.7%; P = .30).CONCLUSIONS: Adjuvant chemotherapy may improve survival in patients with pathologic stage I NSCLC who have factors associated with high risk for recurrence, such as pathologic T1c or T2a or lymphovascular invasion. (C) 2022 by The Society of Thoracic Surgeons