Department of Cardiothoracic Surgery, Boston Medical Center and Boston University School of Medicine, Boston, MA, USA.
J Thorac Cardiovasc Surg. 2011 Jun;141(6):1392-7. doi: 10.1016/j.jtcvs.2010.12.011. Epub 2011 Feb 1.
This study examined the impact of neoadjuvant chemotherapy and concurrent high-dose radiation therapy on survival in patients with node-negative T3 and T4 non-small cell lung cancer.
A total of 110 consecutive patients underwent surgical resection for invasive T3N0M0 (94 patients) and T4N0M0 (16 patients) non-small cell lung cancer between 1979 and 2008. Forty-seven patients received neoadjuvant chemotherapy and concurrent high-dose (5940 cGy) radiation therapy before resection (Chemo-RT group). Sixty-three patients underwent surgical resection without receiving induction chemoradiotherapy (Surg group), of whom 21 received neoadjuvant radiation, 19 received adjuvant radiation, 17 received surgery alone, 2 received adjuvant chemotherapy, 2 received adjuvant chemoradiotherapy, and 2 received brachytherapy. Survival of the Chemo-RT and Surg groups was compared using both crude and adjusted Cox proportional hazards models.
The 5-year, 10-year, and median survivals were 61%, 50%, and 90 months, respectively, in the Chemo-RT group versus 22%, 14%, and 22 months, respectively, in the Surg group. Subjects in the Surg group had an increased risk of death (hazard ratio, 2.60; 95% confidence interval, 1.62-4.18; P = .0001) compared with the Chemo-RT group. After adjustment for potential confounding variables of age, sex, tumor size, tumor location, type of operation, and decade of care, subjects in the Surg group remained at increased risk of death (hazard ratio, 2.81; 95% confidence interval, 1.45-5.44, P = .002) compared with the Chemo-RT group.
Aggressive treatment of node-negative invasive T3 and T4 NSCLC with induction chemoradiotherapy may significantly prolong survival. This approach should be evaluated in a prospective multicenter national trial.
本研究旨在探讨新辅助化疗和同期高剂量放疗对 T3 和 T4 期无淋巴结转移非小细胞肺癌患者生存的影响。
1979 年至 2008 年间，共有 110 例浸润性 T3N0M0（94 例）和 T4N0M0（16 例）非小细胞肺癌患者接受了手术切除。47 例患者在术前接受新辅助化疗和同期高剂量（5940cGy）放疗（化疗-放疗组）。63 例患者接受了手术切除，未接受诱导放化疗（手术组），其中 21 例接受了新辅助放疗，19 例接受了辅助放疗，17 例接受了单纯手术，2 例接受了辅助化疗，2 例接受了辅助放化疗，2 例接受了近距离放疗。使用粗死亡率和调整后的 Cox 比例风险模型比较化疗-放疗组和手术组的生存情况。
化疗-放疗组的 5 年、10 年和中位生存率分别为 61%、50%和 90 个月，而手术组分别为 22%、14%和 22 个月。与化疗-放疗组相比，手术组患者死亡风险增加（风险比，2.60；95%置信区间，1.62-4.18；P=0.0001）。在校正了年龄、性别、肿瘤大小、肿瘤位置、手术类型和治疗年代等潜在混杂因素后，与化疗-放疗组相比，手术组患者死亡风险仍然较高（风险比，2.81；95%置信区间，1.45-5.44；P=0.002）。
对 T3 和 T4 期无淋巴结转移的浸润性非小细胞肺癌患者采用新辅助化疗和同期高剂量放疗的强化治疗可能显著延长生存时间。这种方法应在一项前瞻性多中心全国性试验中进行评估。
