Department of Clinical and Biological Sciences, University of Torino, S. Luigi Hospital, Orbassano, Italy.
J Thorac Oncol. 2009 Dec;4(12):1568-71. doi: 10.1097/JTO.0b013e3181c06980.
Although histology has not consistently been associated with treatment outcome in advanced non-small cell lung cancer, a recent phase III trial comparing pemetrexed plus cisplatin and gemcitabine plus cisplatin (GC) demonstrated better efficacy for pemetrexed plus cisplatin in nonsquamous (adenocarcinoma and large cell carcinoma) carcinoma than in squamous cell carcinoma. Herein, retrospective analysis is used to explore the potential predictive and prognostic role of non-small cell lung cancer histology in patients treated with three first-line, platinum-based regimens.
Survival and time to progression (TTP) data from a phase III trial comparing paclitaxel plus carboplatin (PCb), GC, and vinorelbine plus cisplatin (VC) were analyzed. Using Cox multiple regression, factors for one model included treatment (PCb, GC, and VC), histology (squamous, adenocarcinoma, large cell, and other), gender, Eastern Cooperative Oncology Group performance status (0/1 and 2), stage (IIIB and IV), number of metastatic sites (< or = 1 and >1), and smoking history (yes or no). In another model, histology was simply considered as squamous versus nonsquamous. An interaction value of p < 0.10 was considered significant.
Baseline patient and disease characteristics for the 607 treated patients were balanced among the arms. No significant treatment-by-histology interaction was seen in either model for either end point. Nevertheless, histology was a significant prognostic factor for survival in the first model (p = 0.0183) and marginally significant for TTP (p = 0.0783). Subsequent pairwise comparisons of histology groups demonstrated a survival advantage for squamous cell carcinoma over adenocarcinoma (p = 0.0021).
Histology was not predictive of PCb, GC, or VC treatment effect for either survival or TTP. Histology was prognostic for survival, with better outcomes associated with squamous cell carcinoma.
尽管组织学在晚期非小细胞肺癌的治疗结果中并不一直具有一致性，但最近一项比较培美曲塞加顺铂与吉西他滨加顺铂（GC）的 III 期试验表明，在非鳞状（腺癌和大细胞癌）癌中，培美曲塞加顺铂的疗效优于鳞状细胞癌。在此，通过回顾性分析，探讨了在接受三种一线铂类方案治疗的患者中，非小细胞肺癌组织学的潜在预测和预后作用。
对一项比较紫杉醇加卡铂（PCb）、GC 和长春瑞滨加顺铂（VC）的 III 期试验的生存和进展时间（TTP）数据进行分析。使用 Cox 多因素回归，一个模型的因素包括治疗（PCb、GC 和 VC）、组织学（鳞状、腺癌、大细胞和其他）、性别、东部合作肿瘤学组表现状态（0/1 和 2）、分期（IIIB 和 IV）、转移部位数量（≤1 和>1）和吸烟史（是或否）。在另一个模型中，组织学简单地被视为鳞状与非鳞状。交互值 p<0.10 被认为有统计学意义。
607 例治疗患者的基线患者和疾病特征在各治疗组之间平衡。在两个模型中，对于两个终点，均未观察到治疗与组织学之间的显著相互作用。然而，组织学在第一个模型中是生存的显著预后因素（p=0.0183），在 TTP 中也有边缘显著（p=0.0783）。随后对组织学组的两两比较显示，与腺癌相比，鳞状细胞癌的生存优势显著（p=0.0021）。
组织学对 PCb、GC 或 VC 的治疗效果既没有预测作用，也没有预后作用。组织学对生存具有预后作用，与鳞状细胞癌相关的生存结果更好。
