Department of Thoracic Surgery, Hotel Dieu Hospital, University of Paris V, Paris, France.
J Thorac Cardiovasc Surg. 2010 Aug;140(2):356-63. doi: 10.1016/j.jtcvs.2010.02.018. Epub 2010 Apr 9.
The role of surgery in patients with N2 non-small cell lung cancer is debated. The aim of this study was to evaluate the results of surgical resection after induction chemotherapy.
We retrospectively reviewed the cases of patients with N2 non-small cell lung cancer who underwent neoadjuvant chemotherapy followed by resection between 2001 and 2007. They all had tumors deemed resectable.
One hundred seventy-five patients entered the study. Most of them received 2 or 3 cycles of chemotherapy (81%), in all cases platinum-based regimens. Chemotherapy response rate was 62%. Operations included 96 lobectomies/bilobectomies and 79 pneumonectomies. Complete resection rate was 94%, and perioperative mortality was 4.5%. A pathologic mediastinal downstaging was found in 39% of patients. Overall median survival time and 5-year survival were 34.7 months and 30%, respectively. Survival was affected by clinical response (median survival time 51 months and 5-year survival 42% for responders versus 19 months and 10% for nonresponders) and by nodal downstaging (51 months and 45% versus 25% and 22%). In the group of responders, nondownstaged patients showed satisfying survival (median survival time 30 months, 5-year survival 30%). In the group of nonresponders, survival was unsatisfactory when a lobectomy was performed (median survival time 20 months, 5-year survival 13%) and poor in case of pneumonectomy (15 months and 6%). Multivariate analysis found 4 factors significantly affecting survival: clinical response, nodal downstaging, number of chemotherapy cycles, and histopathologic response.
Surgery after chemotherapy could be effective for selected patients with N2 non-small cell lung cancer. Survival for responders is satisfactory, even in case of persistent N2 disease. Prognosis for nonresponders is disappointing.
手术在 N2 非小细胞肺癌患者中的作用存在争议。本研究旨在评估新辅助化疗后行切除术的结果。
我们回顾性分析了 2001 年至 2007 年间接受新辅助化疗后行切除术的 N2 非小细胞肺癌患者的病例。所有患者的肿瘤均被认为可切除。
175 例患者入组本研究。大多数患者接受了 2 或 3 个周期的化疗（81%），均采用含铂方案。化疗有效率为 62%。手术包括 96 例肺叶切除术/双肺叶切除术和 79 例全肺切除术。完全切除率为 94%，围手术期死亡率为 4.5%。39%的患者纵隔降期。总体中位生存时间和 5 年生存率分别为 34.7 个月和 30%。生存受临床反应（中位生存时间 51 个月和 5 年生存率 42%对无反应者 19 个月和 10%）和淋巴结降期（51 个月和 45%对无降期者 25%和 22%）的影响。在反应者中，无淋巴结降期患者的生存情况令人满意（中位生存时间 30 个月，5 年生存率 30%）。在无反应者中，行肺叶切除术时生存情况不佳（中位生存时间 20 个月，5 年生存率 13%），行全肺切除术时生存情况较差（15 个月，6%）。多因素分析发现 4 个因素显著影响生存：临床反应、淋巴结降期、化疗周期数和组织病理学反应。
化疗后手术可能对选择的 N2 非小细胞肺癌患者有效。反应者的生存情况令人满意，即使存在持续的 N2 疾病。无反应者的预后令人失望。
