Factors Associated With Local and Distant Recurrence and Survival in Patients With Resected Nonsmall Cell Lung Cancer
Factors Associated With Local and Distant Recurrence and Survival in Patients With Resected Nonsmall Cell Lung Cancer
复制标题
DOI：
10.1002/cncr.24133
复制
发表时间：
2009-03-01
期刊：
影响因子：
6.2
通讯作者：
DeCamp, Malcolm M.
中科院分区：
文献类型：
--
作者：
Varlotto, John M.;Recht, Abram;DeCamp, Malcolm M.
背景技术背景：本研究评估了手术、组织病理学和患者相关因素对I至IIIA期非小细胞肺癌（NSCLC）患者局部和远处复发风险以及总生存率的影响，这些患者接受了明确切除术，伴或不伴辅助化疗。方法：该研究纳入了2000年至2005年期间接受治疗的373例连续患者，这些患者未接受辅助或新辅助放疗，至少随访3个月，并且在诊断为NSCLC的5年内没有其他癌症病史。其中，52%患有IA期疾病，30%患有IB期，5%患有IIA期，8%患有IIB期，5%患有III期疾病。44例患者接受化疗。结果：中位随访时间为33个月。2年、3年和5年的局部失败率分别为16%、22%和32%;远端复发率分别为13%、15%和21%。多变量分析显示，局部复发与淋巴管或血管浸润（LVI）、化疗的使用和糖尿病的存在显著相关;远处复发在非鳞状细胞组织学、接受肺切除术和TNM分期更晚期的患者中显著更高。生存率与年龄、心肌梗死史、肺切除术、组织学、LVI和N1阳性淋巴结数量显著相关。结论：局部复发是本系列中失败的主要类型。糖尿病或LVI患者可能受益于无症状局部复发的密切监测和积极治疗，特别是在手术外给予化疗时。Cancer 2009;115：1059-69. (c)2009年美国癌症协会。
BACKGROUND: This study assessed the impact of surgical, histopathologic and patient-related factors on the risks of local and distant recurrence and overall survival for patients with stages I through IIIA nonsmall cell lung carcinoma (NSCLC) undergoing definitive resection with or without adjuvant chemotherapy. METHODS: This study included 373 consecutive patients treated between 2000 and 2005 who did not receive adjuvant or neoadjuvant radiotherapy, had at least 3 months of follow-up, and did not have a history of other cancers within 5 years of the diagnosis of their NSCLC. Of these, 52% had pathologic stage IA disease, 30% had stage IB, 5% had stage IIA, 8% had stage IIB and 5% had stage III disease. Forty-four patients received chemotherapy. RESULTS: The median follow-up was 33 months. Local failure rates at 2 years, 3 years, and 5 years were 16%, 22%, and 32%, respectively; distant recurrence rates were 13%, 15%, and 21%, respectively. Multivariable analysis revealed that local recurrence was significantly associated with the presence of lymphatic or vascular invasion (LVI), the use of chemotherapy, and having diabetes; distant recurrence was significantly higher in patients with nonsquamous cell histology, those undergoing pneumonectomy, and those with more advanced TNM stage. Survival was significantly associated with age, history of myocardial infarction, performance of a pneumonectomy, histology, LVI, and the number of positive N1 lymph nodes. CONCLUSIONS: Local recurrence was the predominant type of failure in this series. Patient with diabetes or LVI may benefit from close surveillance and aggressive therapy of asymptomatic local recurrences, especially when chemotherapy is given in addition to surgery. Cancer 2009;115:1059-69. (c) 2009 American Cancer Society.