Toyooka Shinichi, Kiura Katsuyuki, Shien Kazuhiko, Katsui Kuniaki, Hotta Katsuyuki, Kanazawa Susumu, Date Hiroshi, Miyoshi Shinichiro
Department of Thoracic Surgery, Okayama University Hospital, Okayama, Japan.
Interact Cardiovasc Thorac Surg. 2012 Dec;15(6):954-60. doi: 10.1093/icvts/ivs412. Epub 2012 Sep 12.
The purpose of this study was to compare the clinical outcomes of induction chemoradiotherapy and chemotherapy and to identify the prognostic factors for non-small-cell lung cancer patients with mediastinal lymph node metastasis who were treated with induction therapy.
Between August 1995 and December 2010, 50 non-small-cell lung cancer patients with pathological mediastinal lymph node metastasis were scheduled to receive induction therapy followed by surgery. Irinotecan plus cisplatin was used for induction chemotherapy from June 1995 to April 1999, and docetaxel plus cisplatin with concurrent radiation at a dose of 40-46 Gy has been used for induction chemoradiotherapy since May 1999.
Thirty-five patients were treated with induction chemoradiotherapy and 15 were treated with induction chemotherapy. For the entire population, the 3-year and 5-year overall survival rates were 64.1 and 53.9%, respectively, and the 1-year and 2-year disease-free survival rates were 70.0 and 53.1%, respectively. Among the clinicopathological factors, the chemoradiotherapy group exhibited longer overall survival and disease-free survival than the chemotherapy group (overall survival, P = 0.0020; disease-free survival, P = 0.015). Pathological downstaging was also significantly associated with favorable overall survival (P = 0.0042) and disease-free survival (P = 0.021). A multivariate analysis showed that chemoradiotherapy (P = 0.0099) and pathological downstaging (P = 0.039) were independent prognostic factors.
Our results indicated that induction chemoradiotherapy was superior to induction chemotherapy with regard to the outcome of non-small-cell lung cancer patients with mediastinal lymph node metastasis.
本研究旨在比较诱导放化疗与单纯化疗的临床疗效，并确定接受诱导治疗的非小细胞肺癌纵隔淋巴结转移患者的预后因素。
1995年8月至2010年12月期间，50例经病理证实纵隔淋巴结转移的非小细胞肺癌患者计划接受诱导治疗后行手术。1995年6月至1999年4月采用伊立替康联合顺铂进行诱导化疗，自1999年5月起采用多西他赛联合顺铂并同步放疗，剂量为40 - 46 Gy进行诱导放化疗。
35例患者接受诱导放化疗，15例接受诱导化疗。对于全部患者，3年和5年总生存率分别为64.1%和53.9%，1年和2年无病生存率分别为70.0%和53.1%。在临床病理因素中，放化疗组的总生存和无病生存时间均长于化疗组（总生存，P = 0.0020；无病生存，P = 0.015）。病理降期也与良好的总生存（P = 0.0042）和无病生存（P = 0.021）显著相关。多因素分析显示，放化疗（P = 0.0099）和病理降期（P = 0.039）是独立的预后因素。
我们的结果表明，对于纵隔淋巴结转移的非小细胞肺癌患者，诱导放化疗在疗效方面优于诱导化疗。
