Steger Volker, Veit Stefanie, Walker Tobias, Friedel Godehard, Lehrach Karoline, Mustafi Migdat, Walles Thorsten
Clinic of Thoracic, Cardiac and Vascular Surgery, Tübingen University, Tübingen, Germany.
Thorac Cardiovasc Surg. 2013 Mar;61(2):109-15. doi: 10.1055/s-0032-1311529. Epub 2012 Jul 20.
For stage III, NSCLC neoadjuvant protocols have been intensified up to full dose protocols but up till now the effect of more intensive protocols in a trimodal setting could not be compared directly because of different selection criteria or experience of involved facilities in different studies or multicenter studies. We analyzed our experience with two different neoadjuvant protocols, consistent selection criteria, and surgical teams over 17-year time period.
Single-center retrospective study in 159 patients concerning survival, recurrence, and downstaging effect.
Overall median survival was 32 months, with 26 months for protocol 1, and 35 months for protocol 2, respectively. Hospital mortality was 5%. Log-rank test showed significant difference between the protocols for UICC-downstaging-effect, ypT-stage, ypN-stage, and ypUICC-stage, respectively, but only ypN-stage and ypUICC-stage were significant risk factors for survival using Cox regression.
The median survival benefit of 9 months is evident but (probably still) not significant. The more aggressive protocol 2 shows a significant better downstaging effect concerning N- and UICC-stage if R0-resection can be achieved. Insofar dose does matter!
对于Ⅲ期非小细胞肺癌（NSCLC），新辅助治疗方案已强化至全剂量方案，但由于不同研究或多中心研究中参与机构的选择标准或经验不同，迄今为止，在三联治疗模式下更强化方案的效果无法直接比较。我们分析了17年间使用两种不同新辅助治疗方案、一致的选择标准以及手术团队的经验。
对159例患者进行单中心回顾性研究，涉及生存、复发和降期效果。
总体中位生存期为32个月，方案1为26个月，方案2为35个月。医院死亡率为5%。对数秩检验显示，两种方案在国际抗癌联盟（UICC）降期效果、ypT分期、ypN分期和ypUICC分期方面分别存在显著差异，但使用Cox回归分析时，只有ypN分期和ypUICC分期是生存的显著危险因素。
9个月的中位生存获益是明显的，但（可能仍然）不显著。如果能实现R0切除，更积极的方案2在N分期和UICC分期方面显示出显著更好的降期效果。因此，剂量确实很重要！
