Luo Hui, Qiao Lili, Liang Ning, Zhang Jiandong
Division of Graduated, Weifang Medical College, Shandong, P.R. China.
J BUON. 2015 May-Jun;20(3):791-9.
To evaluate the rates of locoregional failure (LRF) vs distant metastasis (DM), and find risk factors for recurrence in patients with completely resected N1 non-small cell lung cancer (NSCLC).
By searching Pubmed, Embase and the Cochrane Controlled Trials Register from 1995 through 2014, eligible randomized clinical trials (RCTs) were identified. In addition, the reference lists of articles and conference abstracts were searched. The logarithm of the risk ratio (RR) and its standard error (SE) were calculated, and a fixed-effect model was used to combine the estimates.
3 RCTs and 9 retrospective studies, which included 889 patients, were identified and selected. All studies dealt with resected N1 NSCLC, LRF vs DM, and risk factors such as visceral pleural invasion (VPI) and lymphovascular invasion (LVI). There was statistically significant benefit on 5-year overall survival (OS) for LRF (RR=0.68,95% CI=0.60-0.78, p<0.00001). Further analysis for patients with LRF also showed that VPI (RR=1.25, 95% confidence interval/CI=1.09-1.42, p=0.0009), LVI (RR=1.16, 95% CI=1.04-1.30, p=0.009), were the main risk factors for recurrence.
The present study indicates that in patients with resected N1 NSCLC, the incidence of LRF is lower than DM. Advanced T stage classification, VPI, and LVI were predictors of poor survival. These patients represent a subgroup with N1 disease who might benefit from additional therapy, including adjuvant radiotherapy (RT). However, large, well-designed prospective studies should be conducted to confirm this conclusion.
评估完全切除的N1期非小细胞肺癌（NSCLC）患者的局部区域复发（LRF）与远处转移（DM）发生率，并找出复发的危险因素。
通过检索1995年至2014年的PubMed、Embase和Cochrane对照试验注册库，确定符合条件的随机临床试验（RCT）。此外，还检索了文章的参考文献列表和会议摘要。计算风险比（RR）的对数及其标准误（SE），并使用固定效应模型合并估计值。
确定并选择了3项RCT和9项回顾性研究，共纳入889例患者。所有研究均涉及切除的N1期NSCLC、LRF与DM，以及诸如脏层胸膜侵犯（VPI）和淋巴管侵犯（LVI）等危险因素。LRF对5年总生存期（OS）有统计学显著益处（RR=0.68，95%CI=0.60-0.78，p<0.00001）。对LRF患者的进一步分析还表明，VPI（RR=1.25，95%置信区间/CI=1.09-1.42，p=0.0009）、LVI（RR=1.16，95%CI=1.04-1.30，p=0.009）是复发的主要危险因素。
本研究表明，在切除的N1期NSCLC患者中，LRF的发生率低于DM。晚期T分期、VPI和LVI是生存不良的预测因素。这些患者代表了N1期疾病的一个亚组，可能从包括辅助放疗（RT）在内的额外治疗中获益。然而，应进行大规模、设计良好的前瞻性研究以证实这一结论。
