Section of Thoracic Surgery, Yale University School of Medicine, New Haven, Connecticut.
Ann Thorac Surg. 2011 Jul;92(1):233-41; discussion 241-3. doi: 10.1016/j.athoracsur.2011.03.001. Epub 2011 May 28.
Surgical intervention after chemoradiation for locoregionally advanced non-small cell lung cancer (NSCLC) is controversial. This study evaluated patient survival after neoadjuvant chemoradiation and anatomic pulmonary resections for locoregionally advanced NSCLC.
Clinicopathologic data were retrospectively collected for 233 patients (110 women, 123 men) with NSCLC who underwent chemoradiation therapy, followed by pneumonectomy, sleeve lobectomy, bilobectomy, and standard lobectomy, from 1989 to 2008. Univariate log-rank analysis of Kaplan-Meier survival curves and multivariate Cox regression analysis was performed.
Final pathologic stages were complete responders, 52 (22%); I, 56 (24%); II, 39 (17%); and III, 86 (37%). Final pathologic lymph node status was N0, 130 (56%); N1, 28 (12%); and N2, 75 (32%). Overall 5-year survival for the cohort was 43%. The 90-day mortality was 8% (18 of 233). The 5-year survival was 33% for pneumectomy vs 51% for lobectomy (p=0.002). Survival rates at 5 years by stage were complete responders, 58%; I, 50%; II, 41%; and III, 32%; by primary tumor status, T0, 50%; T2, 38%; T3, 29%; and T4, 28%; and by final pathologic nodal status, N0, 51%; N1, 40%; N2, 32% (N0 vs N1, p=0.236; N1 vs N2, p=0.704; N0 vs N2, p=0.019; N0 vs N1+N2, p=0.020). Multivariate analysis demonstrated pneumonectomy was associated with decreased 5-year survival (hazard risk, 1.5162; 95% confidence interval, 10.05028 to 2.189, p=0.0263).
Respectable survival can be achieved after neoadjuvant chemoradiation, followed by anatomic resection, in selected patients with clinically advanced NSCLC. A T0 primary tumor or N0 lymph node status individually, or together as a complete response (T0 N0) status, is associated with the best long-term survival. Survival is most favorable for lobectomies vs pneumonectomies after neoadjuvant chemoradiation therapy.
对于局部晚期非小细胞肺癌（NSCLC），放化疗后进行手术干预存在争议。本研究评估了新辅助放化疗后行解剖性肺切除术治疗局部晚期 NSCLC 患者的生存情况。
回顾性收集了 1989 年至 2008 年间，233 例接受放化疗后行全肺切除术、袖状肺叶切除术、双肺叶切除术和标准肺叶切除术的 NSCLC 患者的临床病理资料。采用 Kaplan-Meier 生存曲线的单因素对数秩检验和多因素 Cox 回归分析。
最终病理分期为完全缓解者 52 例（22%）、Ⅰ期 56 例（24%）、Ⅱ期 39 例（17%）和Ⅲ期 86 例（37%）。最终病理淋巴结状态为 N0 者 130 例（56%）、N1 者 28 例（12%）和 N2 者 75 例（32%）。全组患者 5 年总生存率为 43%。90 天死亡率为 8%（233 例中有 18 例）。全肺切除术 5 年生存率为 33%，肺叶切除术为 51%（p=0.002）。按分期的 5 年生存率分别为完全缓解者 58%、Ⅰ期 50%、Ⅱ期 41%和Ⅲ期 32%；按原发肿瘤状态的 5 年生存率分别为 T0 者 50%、T2 者 38%、T3 者 29%和 T4 者 28%；按最终病理淋巴结状态的 5 年生存率分别为 N0 者 51%、N1 者 40%、N2 者 32%（N0 与 N1 比较，p=0.236；N1 与 N2 比较，p=0.704；N0 与 N2 比较，p=0.019；N0 与 N1+N2 比较，p=0.020）。多因素分析显示，全肺切除术与 5 年生存率降低相关（风险比，1.5162；95%置信区间，10.05028 至 2.189，p=0.0263）。
对于临床局部晚期 NSCLC 患者，新辅助放化疗后行解剖性肺切除术可获得令人满意的生存。T0 期原发肿瘤或 N0 期淋巴结状态，或作为完全缓解（T0N0）状态，与长期生存情况最佳相关。与全肺切除术相比，新辅助放化疗后行肺叶切除术的生存情况更优。
