Department of Thoracic, Cardiac and Vascular Surgery, Tuebingen University, Tuebingen, Germany.
Eur J Cardiothorac Surg. 2012 Apr;41(4):880-5; discussion 885. doi: 10.1093/ejcts/ezr160. Epub 2012 Jan 10.
Lung cancer is the leading cause of death in cancer statistics throughout developed countries. While single surgical approach provides best results in early stages, multimodality approaches have been employed in advanced disease and demonstrated superior results in selected patients. With either full-dose chemotherapy and/or radiotherapy, patients usually have a poor general condition when entering surgical therapy and therefore neoadjuvant therapy can lead to a higher morbidity and mortality. Especially in the case of pneumonectomy as the completing procedure, mortality rate can exceed over 40%. Therefore, chest physicians often shy away from recommending pneumonectomy as final step in trimodal protocols. We analysed our experience with pneumonectomy after neoadjuvant chemoradiotherapy in advanced non-small-cell lung cancer (NSCLC) with a focus on feasibility, outcome and survival.
Retrospective, single-centre study of 146 patients with trimodal neoadjuvant therapy for NSCLC Stage III over 17 years time span. Follow-up was taken from our own outpatient files and with survival check of central registry office in Baden-Württemberg, Germany.
A total of 118 men and 28 women received 62 lobectomies, 6 bi-lobectomies and 78 pneumonectomies after two different neoadjuvant protocols for Stage III NSCLC. Overall morbidity rate was 53 and 56% after pneumonectomy. Overall hospital mortality rate was 4.8 and 6.4% after pneumonectomy. Overall median survival rate was 31 months with a 5-year survival rate of 38% (Kaplan-Meier). Pneumonectomy, right-sited pneumonectomy and initial T- and N-stages were no risk factors for survival (log-rank test). Significant factors for survival were ypT-stage, ypN-stage, yUICC-stage in univariate testing (log-rank test) and ypUICC-stage in multivariate testing (Cox's regression).
Pneumonectomy in neoadjuvant trimodal approach for Stage III NSCLC can be done safe with acceptable mortality rate. Patients should not withhold from operation because of necessitating pneumonectomy. Not the procedure but the selection, response rate and R0-resection are crucial for survival after trimodal therapy in experienced centres.
肺癌是发达国家癌症统计数据中导致死亡的主要原因。虽然单一手术方法在早期阶段提供了最佳结果，但在晚期疾病中已经采用了多模式方法，并在选定的患者中显示出更好的结果。通过全剂量化疗和/或放疗，患者在进入手术治疗时通常身体状况不佳，因此新辅助治疗可能会导致更高的发病率和死亡率。特别是在全肺切除术作为完成手术的情况下，死亡率可能超过 40%。因此，胸部医生通常不愿推荐全肺切除术作为三联方案的最后步骤。我们分析了我们在晚期非小细胞肺癌（NSCLC）接受新辅助放化疗后的全肺切除术经验，重点关注可行性、结果和生存。
回顾性分析了 17 年间接受三联新辅助治疗的 146 例 NSCLC III 期患者。随访来自我们自己的门诊病历，并通过德国巴登-符腾堡州中央登记处进行生存检查。
共有 118 名男性和 28 名女性接受了 62 例肺叶切除术、6 例双肺叶切除术和 78 例全肺切除术，这些患者接受了两种不同的 III 期 NSCLC 新辅助方案。全肺切除术后总发病率为 53%和 56%。全肺切除术后总住院死亡率为 4.8%和 6.4%。中位总生存期为 31 个月，5 年生存率为 38%（Kaplan-Meier）。全肺切除术、右肺全肺切除术以及初始 T 和 N 期不是生存的危险因素（对数秩检验）。在单因素检验（对数秩检验）中，生存的显著因素是 ypT 期、ypN 期、ypUICC 期，在多因素检验（Cox 回归）中是 ypUICC 期。
在 III 期 NSCLC 的新辅助三联方案中进行全肺切除术是安全的，死亡率可接受。患者不应因为需要全肺切除术而拒绝手术。在经验丰富的中心，不是手术本身，而是选择、反应率和 R0 切除对三联治疗后的生存至关重要。
