Socinski Mark A, Stinchcombe Thomas E, Hayes D Neil, Morris David E
The Multidisciplinary Thoracic Oncology Program, Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill, NC 27599-7305, USA.
Semin Oncol. 2006 Feb;33(1 Suppl 1):S32-8. doi: 10.1053/j.seminoncol.2005.12.006.
Surgical resection remains the foundation of curative therapy in early stage non-small cell lung cancer (NSCLC). Recent evidence from several randomized trials has shown that adjuvant chemotherapy regimens of platinum-based agents plus third-generation cytotoxic agents improve survival rates in this population of patients. Despite the use of adjuvant chemotherapy, many patients will suffer a relapse, typically systemic, and be candidates for subsequent therapies. This represents a new population of patients with NSCLC. To date, there are no published trials that evaluate prognostic factors or therapeutic outcomes in these patients. Although therapeutic paradigms have been established in patients who present with de novo metastatic NSCLC, it is not clear whether these paradigms are successful for patients who relapse following platinum-based adjuvant chemotherapy. The influence of time from the previous adjuvant exposure is likely to be as important as it seems to be in other solid tumors. However, dedicated clinical research has not yet established this paradigm in NSCLC and the influence this should have on the choice of subsequent therapy is unknown. The nature of the prior adjuvant exposure may also play a role in the choice of subsequent therapy. This has implications for the design of future trials in advanced NSCLC as these patients may or may not have the same natural history as the de novo metastatic NSCLC patient. Future clinical trials are required to address these issues as well as the biologic heterogeneity that likely exists between patients who are seemingly cured by surgery, relapse early (<1 year), or at later times following adjuvant therapy.
手术切除仍然是早期非小细胞肺癌（NSCLC）根治性治疗的基础。多项随机试验的最新证据表明，铂类药物联合第三代细胞毒性药物的辅助化疗方案可提高这类患者的生存率。尽管使用了辅助化疗，但许多患者仍会复发，通常是全身性复发，并成为后续治疗的候选对象。这代表了一类新的NSCLC患者群体。迄今为止，尚无已发表的试验评估这些患者的预后因素或治疗结果。虽然针对初发转移性NSCLC患者已经确立了治疗模式，但尚不清楚这些模式对铂类辅助化疗后复发的患者是否有效。与其他实体瘤一样，距上次辅助治疗的时间影响可能同样重要。然而，专门的临床研究尚未在NSCLC中确立这一模式，其对后续治疗选择的影响也尚不清楚。先前辅助治疗的性质也可能在后续治疗选择中发挥作用。这对晚期NSCLC未来试验的设计具有启示意义，因为这些患者的自然病程可能与初发转移性NSCLC患者相同，也可能不同。未来需要开展临床试验来解决这些问题，以及解决在看似通过手术治愈、早期（<1年）复发或辅助治疗后较晚复发的患者之间可能存在的生物学异质性问题。
