Department of Internal Medicine, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan.
Clin Lung Cancer. 2013 Jul;14(4):418-24. doi: 10.1016/j.cllc.2012.10.003. Epub 2013 Jan 4.
To assess the efficacy and potential prognostic factors of patients with stage III N2 non-small-cell lung cancer (NSCLC) treated with neoadjuvant docetaxel-cisplatin (DP) chemotherapy followed by surgical resection.
Sixty-two patients with NSCLC treated with DP as neoadjuvant chemotherapy between November 2003 and December 2009 were identified and reviewed in this study. Tumor response, survival, and clinicopathologic data were collected retrospectively. The time to event was analyzed by fitting Cox proportional hazards models.
Fifty-eight (94%) of 62 patients eventually underwent surgical resection after DP. The overall clinical response rate to induction DP chemotherapy was 42%. Patients with squamous cell carcinoma (SCC) histology were more likely to response to the DP regimen than those with adenocarcinoma histology (68% vs. 33%, P = .006). With a median follow-up of 82.4 months among the 58 patients, there were 41 (71%) tumor relapses and 27 (47%) deaths. The median event-free survival was 27.5 months (95% CI, 22.3-32.7 months), and the median overall survival was 66.7 months (95% CI, 35.1-98.3 months). In multivariate analysis, when fitting the Cox proportional hazards model, SCC histology (hazard ratio [HR] 0.234 [95% CI, 0.098-0.560]; P = .001) and mediastinal downstaging to N0 (HR 0.451 [95% CI, 0.226-0.898]; P = .024) were independent predictors of better event-free survival.
Neoadjuvant chemotherapy with the DP regimen is both active and well tolerated in patients with stage III N2 NSCLC. SCC histology predicted a better treatment response and survival outcome than adenocarcinoma histology in this patient group. Further investigation of combined-modality treatment is warranted to improve survival in the adenocarcinoma subset of stage III N2 NSCLC.
评估新辅助多西他赛顺铂（DP）化疗后手术切除治疗 III 期 N2 非小细胞肺癌（NSCLC）患者的疗效和潜在预后因素。
本研究回顾性分析了 2003 年 11 月至 2009 年 12 月期间接受 DP 作为新辅助化疗的 62 例 NSCLC 患者。收集肿瘤反应、生存和临床病理数据。采用 Cox 比例风险模型分析时间事件。
62 例患者中有 58 例（94%）最终接受 DP 后手术切除。诱导 DP 化疗的总体临床反应率为 42%。鳞癌（SCC）组织学患者对 DP 方案的反应率高于腺癌组织学患者（68% vs. 33%，P =.006）。在 58 例患者中，中位随访 82.4 个月，有 41 例（71%）肿瘤复发和 27 例（47%）死亡。中位无事件生存时间为 27.5 个月（95%CI，22.3-32.7 个月），中位总生存时间为 66.7 个月（95%CI，35.1-98.3 个月）。多变量分析时，在拟合 Cox 比例风险模型时，SCC 组织学（风险比 [HR] 0.234 [95%CI，0.098-0.560]；P =.001）和纵隔降期至 N0（HR 0.451 [95%CI，0.226-0.898]；P =.024）是无事件生存的独立预测因素。
DP 方案新辅助化疗在 III 期 N2 NSCLC 患者中既有效又耐受良好。在该患者组中，SCC 组织学比腺癌组织学预测更好的治疗反应和生存结局。需要进一步研究联合治疗以改善 III 期 N2 NSCLC 腺癌亚组的生存。
