Kim Se Hyun, Cho Byoung Chul, Choi Hye Jin, Chung Kyung Young, Kim Dae Joon, Park Moo-Suk, Kim Se Kyu, Chang Joon, Shin Sang-Joon, Sohn Joo Hyuk, Kim Joo Hang
Yonsei Cancer Center, Yonsei University College of Medicine, Seoul, Republic of Korea.
Lung Cancer. 2008 Jun;60(3):393-400. doi: 10.1016/j.lungcan.2007.11.004. Epub 2007 Dec 26.
The prognosis of patients with stage III non-small-cell lung cancer (NSCLC) who achieve a pathological complete response or downstaging following neoadjuvant therapies are better than the prognosis of patients with residual metastatic lymph nodes (LN). However, the prognostic significance of the number of residual metastatic LNs remains unclear. From January 2001 to January 2006, 42 consecutive patients with stage IIIAN2 (22 patients) and IIIB without pleural effusion (20 patients) were treated with neoadjuvant chemotherapy. Thirty-four (81.0%) of the 42 patients were pathologically staged by mediastinoscopy. Neoadjuvant chemotherapy consisted of 3 cycles of platinum-based doublet (21 patients with gemcitabine, 15 with paclitaxel, and 6 with docetaxel). After neoadjuvant chemotherapy, a pathological complete response was achieved in one patient and downstaging was achieved in 24 patients. Pathological LN metastasis was absent in 9 patients (21.4%) and present in 33 patients (78.6%). With a median follow-up of 23 months, the 2-year disease-free survival (DFS) rate of patients without residual LN metastasis was statistically better than that of patients with residual LN metastasis (46% vs. 18% respectively, P=0.03). Among 33 patients with residual LN metastasis, age (P=0.01), pathological downstaging (P=0.098) and the number of residual metastatic LNs (median 14 months in 1-4 LN vs. median 5 months in LN > or =5; P=0.011) were significant predictors of DFS in univariate analysis. In multivariate analysis, the number of residual metastatic LNs was an independent predictor of DFS among patients with residual LN metastasis, irrespective of pathological downstaging. The number of residual metastatic lymph nodes following neoadjuvant chemotherapy is an independent predictor of DFS in patients with stage III NSCLC.
在新辅助治疗后达到病理完全缓解或分期降低的Ⅲ期非小细胞肺癌（NSCLC）患者的预后优于有残留转移淋巴结（LN）的患者。然而，残留转移LN数量的预后意义仍不清楚。从2001年1月至2006年1月，42例连续的ⅢA N2期（22例）和无胸腔积液的ⅢB期（20例）患者接受了新辅助化疗。42例患者中的34例（81.0%）通过纵隔镜进行了病理分期。新辅助化疗由3个周期的铂类双联方案组成（21例使用吉西他滨，15例使用紫杉醇，6例使用多西他赛）。新辅助化疗后，1例患者达到病理完全缓解，24例患者分期降低。9例患者（21.4%）无病理LN转移，33例患者（78.6%）有病理LN转移。中位随访23个月，无残留LN转移患者的2年无病生存率（DFS）在统计学上优于有残留LN转移的患者（分别为46%对18%，P = 0.03）。在33例有残留LN转移的患者中进行单因素分析，年龄（P = 0.01）、病理分期降低（P = 0.098）和残留转移LN数量（1 - 4个LN时中位生存14个月，LN≥5个时中位生存5个月；P = 0.011）是DFS的显著预测因素。在多因素分析中，残留转移LN数量是有残留LN转移患者DFS的独立预测因素，与病理分期降低无关。新辅助化疗后残留转移淋巴结数量是Ⅲ期NSCLC患者DFS的独立预测因素。
