Mamon Harvey J, Yeap Beow Yong, Jänne Pasi A, Reblando Jason, Shrager Sarah, Jaklitsch Michael T, Mentzer Steven, Lukanich Jeanne M, Sugarbaker David J, Baldini Elizabeth H, Berman Stuart, Skarin Arthur, Bueno Raphael
Department of Radiation Oncology and Medical Oncology, Dana-Farber/Brigham and Women's Hospital, 75 Francis St, Boston, MA 02115, USA.
J Clin Oncol. 2005 Mar 1;23(7):1530-7. doi: 10.1200/JCO.2005.04.123.
Lung cancer is the leading cause of cancer mortality in the United States. We sought to review our experience with surgically staged IIIA (N2) non-small-cell lung cancer (NSCLC), focusing on the patterns of failure in consecutively treated patients from 1988 to 2000.
The records of 177 patients were reviewed. Collected data included stage, histology, use of chemotherapy and radiation, initial and subsequent sites of failure, and survival. One hundred twenty-four patients have died; follow-up time is 35 months among the remaining patients.
The median survival from the time of surgery was 21.0 months, with a 3-year overall survival (OS) of 34%. Nodal downstaging to N0 disease correlated with OS and progression-free survival (PFS; P < .001). The most common site of recurrence was the brain. Thirty-four percent of patients recurred in the brain as their first site of failure, and 40% of patients developed brain metastases at some point in their course. In patients with nonsquamous histology and residual nodal involvement after neoadjuvant therapy, the risk of brain metastases was 53% at 3 years.
Patients treated with neoadjuvant therapy for N2-positive stage IIIA NSCLC enjoy an advantage in both OS and PFS if their lymph node status is downstaged to N(0). Because brain metastases constitute the most common site of failure in these patients, future studies focusing on prophylaxis of brain metastases may improve the outcome in patients with stage IIIA NSCLC.
肺癌是美国癌症死亡的主要原因。我们试图回顾我们在手术分期为IIIA期（N2）的非小细胞肺癌（NSCLC）方面的经验，重点关注1988年至2000年连续治疗患者的失败模式。
回顾了177例患者的记录。收集的数据包括分期、组织学、化疗和放疗的使用情况、初始和后续的失败部位以及生存率。124例患者已经死亡；其余患者的随访时间为35个月。
手术时的中位生存期为21.0个月，3年总生存率（OS）为34%。淋巴结降期至N0疾病与OS和无进展生存期（PFS；P < .001）相关。最常见的复发部位是脑。34%的患者以脑作为其首个失败部位复发，40%的患者在病程中的某个时间点发生脑转移。在新辅助治疗后组织学为非鳞状且有残留淋巴结受累的患者中，3年时脑转移风险为53%。
对于N2阳性的IIIA期NSCLC患者，若其淋巴结状态降期至N0，新辅助治疗可使其在OS和PFS方面均获益。由于脑转移是这些患者最常见的失败部位，未来针对脑转移预防的研究可能会改善IIIA期NSCLC患者的预后。
