非小细胞肺癌诱导治疗后连续100例肺切除术：风险与获益之间的不确定平衡
One hundred consecutive pneumonectomies after induction therapy for non-small cell lung cancer: an uncertain balance between risks and benefits.
作者信息
Doddoli Christophe, Barlesi Fabrice, Trousse Delphine, Robitail Stéphane, Yena Sadio, Astoul Philippe, Giudicelli Roger, Fuentes Pierre, Thomas Pascal
机构信息
Department of Thoracic Surgery, Université de la Méditeranée, Sainte-Marguerite Hospital, Marseille, France.
出版信息
J Thorac Cardiovasc Surg. 2005 Aug;130(2):416-25. doi: 10.1016/j.jtcvs.2004.11.022.
OBJECTIVE
We sought to assess postoperative outcome after pneumonectomy after neoadjuvant therapy in patients with non-small cell lung cancer.
METHODS
This retrospective study included 100 patients treated from January 1989 through December 2003 for a primary lung cancer in whom pneumonectomy had been performed after an induction treatment. Surgical intervention had not been considered initially for the following reasons: N2 disease (stage IIIA, n = 79), doubtful resectability (stage IIIB [T4, N0], n = 19), and M1 disease (stage IV [T2, N0, M1, solitary brain metastasis], n = 2). All patients received a 2-drug platinum-based regimen with a median of 2.5 cycles (range, 2-4 cycles), and 30 had associated radiotherapy (30-45 Gy).
RESULTS
There were 55 right and 45 left resections. Overall 30-day and 90-day mortality rates were 12% and 21%, respectively. At multivariate analysis, one independent prognostic factor entered the model to predict 30-day mortality: postoperative cardiovascular event (relative risk, 45.7; 95% confidence interval, 3.7-226.7; P = .001). Four variables predicted 90-day mortality: age of more than 60 years (relative risk, 5.06; 95% confidence interval, 1.47-17.48; P = .01), male sex (relative risk, 8.25; 95% confidence interval, 1.01-67.34; P = .049), postoperative respiratory event (relative risk, 3.64; 95% confidence interval, 1.14-9.37; P = .007), and postoperative cardiovascular event (relative risk, 7.84; 95% confidence interval, 3.12-19.71; P < .001). Estimated overall survivals in 90-day survivors were 35% (range, 29%-41%) and 25% (range, 19.3%-30.7%) at 3 and 5 years, respectively. At multivariate analysis, one independent prognostic factor entered the model: pathologic stage III-IV residual disease (relative risk, 1.89; 95% confidence interval, 1.09-3.26; P = .022).
CONCLUSIONS
Pneumonectomy after induction therapy is a high-risk procedure, the survival benefit of which appears uncertain.
目的
我们试图评估新辅助治疗后接受肺切除术的非小细胞肺癌患者的术后结局。
方法
这项回顾性研究纳入了1989年1月至2003年12月期间因原发性肺癌接受诱导治疗后行肺切除术的100例患者。最初未考虑手术干预的原因如下：N2期疾病（IIIA期，n = 79）、可切除性存疑（IIIB期[T4，N0]，n = 19）和M1期疾病（IV期[T2，N0，M1，孤立性脑转移]，n = 2）。所有患者均接受含铂双药方案，中位疗程为2.5个周期（范围2 - 4个周期），30例患者接受了辅助放疗（30 - 45 Gy）。
结果
右肺切除55例，左肺切除45例。30天和90天的总死亡率分别为12%和21%。多因素分析显示，有一个独立的预后因素进入模型以预测30天死亡率：术后心血管事件（相对风险，45.7；95%置信区间，3.7 - 226.7；P = 0.001）。有四个变量可预测90天死亡率：年龄超过60岁（相对风险，5.06；95%置信区间，1.47 - 17.48；P = 0.01）、男性（相对风险，8.25；95%置信区间，1.01 - 67.34；P = 0.049）、术后呼吸事件（相对风险，3.64；95%置信区间，1.14 - 9.37；P = 0.007）和术后心血管事件（相对风险，7.84；95%置信区间，3.12 - 19.71；P < 0.001）。90天存活患者的3年和5年估计总生存率分别为35%（范围29% - 41%）和25%（范围19.3% - 30.7%）。多因素分析显示，有一个独立的预后因素进入模型：病理III - IV期残留疾病（相对风险，1.89；9%置信区间，1.09 - 3.26；P = 0.022）。
结论
诱导治疗后行肺切除术是一项高风险手术，其生存获益似乎不确定。
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