Departments of Thoracic and Cardiovascular Surgery, the University of Texas M. D. Anderson Cancer Center, Houston, TX 77030, USA.
J Thorac Oncol. 2012 May;7(5):825-32. doi: 10.1097/JTO.0b013e318247504a.
We evaluated the ability of histopathologic response criteria to predict overall survival (OS) and disease-free survival (DFS) in patients with surgically resected non-small cell lung cancer (NSCLC) treated with or without neoadjuvant chemotherapy.
Tissue specimens from 358 patients with NSCLC were evaluated by pathologists blinded to the patient treatment and outcome. The surgical specimens were reviewed for various histopathologic features in the tumor including percentage of residual viable tumor cells, necrosis, and fibrosis. The relationship between the histopathologic findings and OS was assessed.
The percentage of residual viable tumor cells and surgical pathologic stage were associated with OS and DFS in 192 patients with NSCLC receiving neoadjuvant chemotherapy in multivariate analysis (p = 0.005 and p = 0.01, respectively). There was no association of OS or DFS with percentage of viable tumor cells in 166 patients with NSCLC who did not receive neoadjuvant chemotherapy (p = 0.31 and p = 0.45, respectively). Long-term OS and DFS were significantly prolonged in patients who had ≤10% viable tumor compared with patients with >10% viable tumor cells (5 years OS, 85% versus 40%, p < 0.0001 and 5 years DFS, 78% versus 35%, p < 0.001).
The percentages of residual viable tumor cells predict OS and DFS in patients with resected NSCLC after neoadjuvant chemotherapy even when controlled for pathologic stage. Histopathologic assessment of resected specimens after neoadjuvant chemotherapy could potentially have a role in addition to pathologic stage in assessing prognosis, chemotherapy response, and the need for additional adjuvant therapies.
我们评估了组织病理学反应标准预测接受或不接受新辅助化疗的手术切除非小细胞肺癌（NSCLC）患者总生存期（OS）和无病生存期（DFS）的能力。
病理学家对 358 例 NSCLC 患者的组织标本进行评估，这些患者的治疗和结果对病理学家均为盲态。评估肿瘤中各种组织病理学特征与 OS 的关系，包括残留活肿瘤细胞百分比、坏死和纤维化。
在接受新辅助化疗的 192 例 NSCLC 患者中，残留活肿瘤细胞百分比和手术病理分期与 OS 和 DFS 相关（p = 0.005 和 p = 0.01）。在未接受新辅助化疗的 166 例 NSCLC 患者中，OS 或 DFS 与活肿瘤细胞百分比无关（p = 0.31 和 p = 0.45）。与活肿瘤细胞>10%的患者相比，活肿瘤细胞≤10%的患者 OS 和 DFS 显著延长（5 年 OS，85%对 40%，p < 0.0001 和 5 年 DFS，78%对 35%，p < 0.001）。
即使在控制病理分期的情况下，残留活肿瘤细胞百分比也可以预测接受新辅助化疗的 NSCLC 患者的 OS 和 DFS。新辅助化疗后切除标本的组织病理学评估除了病理分期外，还可能在评估预后、化疗反应和是否需要额外辅助治疗方面发挥作用。
