Keller Steven M, Vangel Mark G, Wagner Henry, Schiller Joan, Herskovic Arnold, Komaki Ritsuko, Gray Robert, Marks Randolph S, Perry Michael C, Livingston Robert B, Johnson David H
Department of Cardiothoracic Surgery, The Montefiore Medical Center, 3400 Bainbridge Ave, Suite 5B, , Bronx, NY 10467, USA.
Lung Cancer. 2003 Oct;42(1):79-86. doi: 10.1016/s0169-5002(03)00274-5.
The occurrence of second primary tumors (SPTs) following adjuvant therapy for resected stages II and IIIa non-small cell lung cancer (NSCLC) was investigated. Data regarding SPTs were prospectively collected in all patients accrued to Eastern Cooperative Group Oncology E3590 (a phase III trial of adjuvant therapy in patients with completely resected stages II and IIIa NSCLC). Four hundred eighty-eight patients were accrued to the study, 242 to the RT arm and 246 to the CRT arm. Median follow-up was 73 months. Thirty patients (6.1%) developed 33 SPTs, 20 in the RT arm and ten in the CRT arm. Ten SPTs occurred within the upper aerodigestive tract, six in the RT arm and four in the CRT arm. Twenty-three SPTs occurred in other organs, 17 in the RT arm and six in the CRT arm. Median time to detection of a SPT for those patients randomized to RT and CRT was 43 and 36 months, respectively. The incidence of SPTs was 1.8% per patient-year of follow-up. Excluding skin tumors, the relative risk of death following diagnosis of a SPT for patients randomized to the CRT arm as compared with those randomized to RT alone was 2.26 (95% confidence interval, 0.78-5.58, P=0.12). Patients are at risk for developing a SPT following resection of stages II and IIIa NSCLC. The majority of SPTs occur outside the aerodigestive tract. Following development of a non-skin SPT, the survival difference between patients who had received adjuvant CRT and those treated with adjuvant RT alone was not significant.
对接受辅助治疗的Ⅱ期和Ⅲa期非小细胞肺癌（NSCLC）患者发生第二原发性肿瘤（SPT）的情况进行了调查。前瞻性收集了参与东部肿瘤协作组E3590（一项Ⅱ期和Ⅲa期NSCLC完全切除患者辅助治疗的Ⅲ期试验）的所有患者的SPT数据。共有488例患者入组该研究，242例进入放疗组，246例进入同步放化疗组。中位随访时间为73个月。30例患者（6.1%）发生了33例SPT，放疗组20例，同步放化疗组10例。10例SPT发生在上呼吸道消化道，放疗组6例，同步放化疗组4例。23例SPT发生在其他器官，放疗组17例，同步放化疗组6例。随机分配至放疗组和同步放化疗组的患者检测到SPT的中位时间分别为43个月和36个月。SPT的发生率为每随访患者年1.8%。排除皮肤肿瘤后，与单纯接受放疗的患者相比，随机分配至同步放化疗组的患者诊断为SPT后的相对死亡风险为2.26（95%置信区间，0.78 - 5.58，P = 0.12）。Ⅱ期和Ⅲa期NSCLC切除术后患者有发生SPT的风险。大多数SPT发生在上呼吸道消化道之外。发生非皮肤SPT后，接受辅助同步放化疗的患者与单纯接受辅助放疗的患者之间的生存差异不显著。
