术前化疗达到病理完全缓解可预测早期非小细胞肺癌的治愈：两项 IFCT 随机试验的联合分析。

Pathologic complete response to preoperative chemotherapy predicts cure in early-stage non-small-cell lung cancer: combined analysis of two IFCT randomized trials.

机构信息

Chest Disease Department, Jean Minjoz University Hospital, Besancon, France.

出版信息

J Thorac Oncol. 2012 May;7(5):841-9. doi: 10.1097/JTO.0b013e31824c7d92.

DOI:10.1097/JTO.0b013e31824c7d92

PMID:22722786

Abstract

INTRODUCTION

Our study aimed to evaluate whether pathologic complete response (pCR) in early-stage non-small-cell lung cancer (NSCLC) after neoadjuvant chemotherapy resulted in improved outcome, and to determine predictive factors for pCR.

METHODS

Eligible patients with stage-IB or -II NSCLC were included in two consecutive Intergroupe Francophone de Cancérologie Thoracique phase-III trials evaluating platinum-based neoadjuvant chemotherapy, with pCR defined by the absence of viable cancer cells in the resected surgical specimen.

RESULTS

Among the 492 patients analyzed, 41 (8.3%) achieved pCR. In the pCR group, 5-year overall survival was 80.0% compared with 55.8% in the non-pCR group (p = 0.0007). In multivariate analyses, pCR was a favorable prognostic factor of overall survival (relative risk = 0.34; 95% confidence interval = 0.18-0.64) in addition to squamous-cell carcinoma, weight loss less than or equal to 5%, and stage-IB disease. Five-year disease-free survival was 80.1% in the pCR group compared to 44.8% in the non-pCR group (p < 0.0001). Two patients (4.9%) in the pCR group experienced disease recurrence compared to 193 patients (42.8%) in the non-pCR group. SCC subtype was the only independent predictor of pCR (odds ratio [OR] = 4.30; 95% confidence interval = 1.90-9.72).

CONCLUSION

Our results showed that pCR after preoperative chemotherapy was a favorable prognostic factor in stage-IB-II NSCLC. Our study is the largest published series evaluating pCRs after preoperative chemotherapy. The only factor predictive of pCR was squamous-cell carcinoma. Identifying molecular predictive markers for pCR may help in distinguishing patients likely to benefit from neoadjuvant chemotherapy and in choosing the most adequate preoperative chemotherapy regimen.

摘要

介绍

本研究旨在评估早期非小细胞肺癌（NSCLC）患者接受新辅助化疗后病理完全缓解（pCR）是否能改善预后，并确定 pCR 的预测因素。

方法

本研究纳入了两项连续的法国胸外科肿瘤学组（IFCT）III 期临床试验中符合条件的 I 期 B 或 II 期 NSCLC 患者，评估了以铂类为基础的新辅助化疗，pCR 定义为切除的手术标本中无存活癌细胞。

结果

在分析的 492 例患者中，有 41 例（8.3%）达到 pCR。在 pCR 组中，5 年总生存率为 80.0%，而非 pCR 组为 55.8%（p=0.0007）。在多变量分析中，pCR 是总生存的有利预后因素（相对风险=0.34；95%置信区间=0.18-0.64），此外还有鳞癌、体重减轻等于或小于 5%和 I 期 B 疾病。在 pCR 组中，5 年无病生存率为 80.1%，而非 pCR 组为 44.8%（p<0.0001）。在 pCR 组中有 2 例（4.9%）患者出现疾病复发，而非 pCR 组中有 193 例（42.8%）患者出现疾病复发。SCC 亚型是 pCR 的唯一独立预测因素（优势比[OR]=4.30；95%置信区间=1.90-9.72）。