Department of Surgery I, Tokyo Medical University Hospital, Tokyo, Japan.
Department of Surgery I, Tokyo Medical University Hospital, Tokyo, Japan.
Chest. 2013 Jun;143(6):1626-1634. doi: 10.1378/chest.12-1717.
The objective of this study was to identify the clinicopathologic factors influencing postrecurrence survival (PRS) in and the effect of postrecurrence therapy (PRT) on patients with completely resected stage I non-small cell lung cancer (NSCLC).
We reviewed the data of 919 patients in whom complete resection of stage I NSCLC had been performed.
Of the 919 patients, 170 (18.5%) had recurrent disease. Initial PRT was performed in 118 patients (69.1%) (surgery in eight, chemotherapy in 79, radiotherapy in 10, and chemoradiotherapy in 21). On multivariate analyses, PRT (hazard ratio [HR], 0.542; 95% CI, 0.344-0.853; P = .008), female sex (HR, 0.487; 95% CI, 0.297-0.801; P = .005), and differentiation (HR, 1.810; 95% CI, 1.194-2.743; P = .005) demonstrated a statistically significant association with favorable PRS. Bone metastasis (HR, 3.288; 95% CI, 1.783-6.062; P < .001), liver metastasis (HR, 4.518; 95% CI, 1.793-11.379; P = .001), chemotherapy (HR, 0.478; 95% CI, 0.236-0.975; P = .040), epidermal growth factor receptor-tyrosine kinase inhibitors treatment (EGFR-TKIs) (HR, 0.460; 95% CI, 0.245-0.862; P = .015), and nonadenocarcinoma (HR, 2.136; 95% CI, 1.273-3.585; P = .004) were independently and significantly associated with PRS in the 118 patients who underwent any PRT. Subgroup analysis with a combination of these five PRS factors in the patients who underwent any PRT revealed median PRS times of 42.4 months for 20 patients lacking all five risk factors and 18.8 months for 98 patients with at least one of these risk factors (P = .001).
PRT, sex, and differentiation were independently associated with PRS. In the patients who underwent any PRT, PRS was related to EGFR-TKIs, chemotherapy, histology, and initial recurrence sites. One challenge for the future will be to create systematic treatment strategies for recurrent NSCLC according to the risk factor status of individual patients.
本研究旨在确定影响完全切除Ⅰ期非小细胞肺癌（NSCLC）患者术后无复发生存期（PRS）的临床病理因素，以及术后复发治疗（PRT）对患者的影响。
我们回顾了 919 例接受完全切除Ⅰ期 NSCLC 患者的资料。
在 919 例患者中，170 例（18.5%）发生了疾病复发。118 例患者接受了初始 PRT（69.1%）（手术 8 例，化疗 79 例，放疗 10 例，放化疗 21 例）。多因素分析显示，PRT（风险比 [HR]，0.542；95%置信区间，0.344-0.853；P=0.008）、女性（HR，0.487；95%置信区间，0.297-0.801；P=0.005）和分化程度（HR，1.810；95%置信区间，1.194-2.743；P=0.005）与良好的 PRS 有统计学意义。骨转移（HR，3.288；95%置信区间，1.783-6.062；P <.001）、肝转移（HR，4.518；95%置信区间，1.793-11.379；P=0.001）、化疗（HR，0.478；95%置信区间，0.236-0.975；P=0.040）、表皮生长因子受体酪氨酸激酶抑制剂（EGFR-TKIs）治疗（HR，0.460；95%置信区间，0.245-0.862；P=0.015）和非腺癌（HR，2.136；95%置信区间，1.273-3.585；P=0.004）与 118 例接受任何 PRT 患者的 PRS 独立且显著相关。在接受任何 PRT 的患者中，将这五个 PRS 因素进行组合的亚组分析显示，在没有这五个危险因素的 20 例患者中，中位 PRS 时间为 42.4 个月，而在有至少一个危险因素的 98 例患者中，中位 PRS 时间为 18.8 个月（P=0.001）。
PRT、性别和分化程度与 PRS 独立相关。在接受任何 PRT 的患者中，PRS 与 EGFR-TKIs、化疗、组织学和初始复发部位有关。未来的一个挑战将是根据个体患者的危险因素状况，为复发性 NSCLC 制定系统的治疗策略。
