Department of Radiation Oncology, Duke University Medical Center, Durham, NC, USA.
J Thorac Cardiovasc Surg. 2011 Nov;142(5):1175-9. doi: 10.1016/j.jtcvs.2011.07.059.
Patients achieving a mediastinal pathologic complete response with neoadjuvant chemotherapy have improved outcomes compared with patients with persistent N2 disease. How to best manage this latter group of patients is unknown, prompting a review of our institutional experience.
All patients who initiated neoadjuvant therapy for non-small-cell lung cancer from 1995 to 2008 were evaluated. The patients were excluded if they had received preoperative radiotherapy, had had a mediastinal pathologic complete response, or had evidence of disease progression after neoadjuvant chemotherapy. The clinical endpoints were calculated using the Kaplan-Meier product-limit method and compared using a log-rank test.
A total of 28 patients were identified. The median follow-up period was 24 months. Several neoadjuvant chemotherapy regimens were used, most commonly carboplatin with vinorelbine (36%) or paclitaxel (32%). A partial response to chemotherapy was noted in 23 (82%) and stable disease was noted in 5 (18%) on postchemotherapy imaging. Resection was performed in 22 of 28 patients, consisting of lobectomy in 14, pneumonectomy in 2, and wedge/segmentectomy in 6 (21/22 R0, 1/22 R1). There were no postoperative deaths. Postoperative therapy (radiotherapy and/or additional chemotherapy) was administered to 12 patients (55%). The remaining 6 patients generally received definitive radiotherapy with or without additional chemotherapy. The overall and disease-free survival rate at 1, 3, and 5 years was 75%, 37%, and 37% and 50%, 23%, and 19%, respectively. The survival rate at 5 years was similar between patients undergoing resection (34%) and those receiving definitive radiotherapy with or without chemotherapy (40%; P = .73).
Disease-free and overall survival was sufficiently high to warrant aggressive local therapy (surgery or radiotherapy) in patients with persistent N2 disease after neoadjuvant chemotherapy.
与持续存在 N2 疾病的患者相比，接受新辅助化疗后纵隔病理完全缓解的患者具有更好的预后。目前尚不清楚如何最好地管理这组患者，这促使我们回顾了我们的机构经验。
评估了 1995 年至 2008 年间所有接受新辅助治疗的非小细胞肺癌患者。如果患者接受过术前放疗、纵隔病理完全缓解或新辅助化疗后疾病进展，则排除在外。使用 Kaplan-Meier 乘积限法计算临床终点，并使用对数秩检验进行比较。
共确定了 28 例患者。中位随访时间为 24 个月。使用了多种新辅助化疗方案，最常用的是卡铂联合长春瑞滨（36%）或紫杉醇（32%）。23 例（82%）患者在化疗后影像学检查中观察到化疗部分缓解，5 例（18%）患者观察到疾病稳定。28 例患者中有 22 例进行了切除术，包括 14 例肺叶切除术、2 例全肺切除术和 6 例楔形/节段切除术（22 例 R0，1 例 R1）。无术后死亡。12 例患者（55%）接受了术后治疗（放疗和/或辅助化疗）。其余 6 例患者通常接受单纯根治性放疗或联合化疗。1、3、5 年的总生存率和无病生存率分别为 75%、37%和 37%、50%、23%和 19%。接受手术切除的患者与接受根治性放疗或联合化疗的患者（40%；P =.73）的 5 年生存率相似。
在新辅助化疗后持续存在 N2 疾病的患者中，无病和总生存率足够高，需要积极的局部治疗（手术或放疗）。
