Hung Jung-Jyh, Wu Yu-Chung, Chou Teh-Ying, Jeng Wen-Juei, Yeh Yi-Chen, Hsu Wen-Hu
Division of Thoracic Surgery, Department of Surgery, Taipei Veterans General Hospital and School of Medicine, National Yang-Ming University, Taipei, Taiwan.
Department of Pathology and Laboratory Medicine, Taipei Veterans General Hospital, Taipei, Taiwan; Institute of Clinical Medicine, National Yang-Ming University, Taipei, Taiwan.
Ann Thorac Surg. 2016 Apr;101(4):1346-53. doi: 10.1016/j.athoracsur.2015.10.075. Epub 2016 Jan 12.
The benefit of adjuvant chemotherapy remains controversial for patients with stage IB non-small-cell lung cancer (NSCLC). This study investigated the effect of adjuvant chemotherapy and the predictors of benefit from adjuvant chemotherapy in patients with stage IB lung adenocarcinoma.
A total of 243 patients with completely resected pathologic stage IB lung adenocarcinoma were included in the study. Predictors of the benefits of improved overall survival (OS) or probability of freedom from recurrence (FFR) from platinum-based adjuvant chemotherapy in patients with resected stage IB lung adenocarcinoma were investigated.
Among the 243 patients, 70 (28.8%) had received platinum-based doublet adjuvant chemotherapy. A micropapillary/solid-predominant pattern (versus an acinar/papillary-predominant pattern) was a significantly worse prognostic factor for probability of FFR (p = 0.033). Although adjuvant chemotherapy (versus surgical intervention alone) was not a significant prognostic factor for OS (p = 0.303), it was a significant prognostic factor for a better probability of FFR (p = 0.029) on multivariate analysis. In propensity-score-matched pairs, there was no significant difference in OS between patients who received adjuvant chemotherapy and those who did not (p = 0.386). Patients who received adjuvant chemotherapy had a significantly better probability of FFR than those who did not (p = 0.043). For patients with a predominantly micropapillary/solid pattern, adjuvant chemotherapy (p = 0.033) was a significant prognostic factor for a better probability of FFR on multivariate analysis.
Adjuvant chemotherapy is a favorable prognostic factor for the probability of FFR in patients with stage IB lung adenocarcinoma, particularly in those with a micropapillary/solid-predominant pattern.
对于ⅠB期非小细胞肺癌（NSCLC）患者，辅助化疗的获益仍存在争议。本研究调查了辅助化疗对ⅠB期肺腺癌患者的影响以及辅助化疗获益的预测因素。
本研究共纳入243例经手术完全切除的病理ⅠB期肺腺癌患者。研究了铂类辅助化疗对切除的ⅠB期肺腺癌患者总生存期（OS）改善或无复发生存概率（FFR）的获益预测因素。
在243例患者中，70例（28.8%）接受了铂类双联辅助化疗。微乳头/实性为主型（相对于腺泡/乳头为主型）是FFR概率的显著不良预后因素（p = 0.033）。虽然辅助化疗（相对于单纯手术干预）不是OS的显著预后因素（p = 0.303），但在多因素分析中，它是FFR概率更高的显著预后因素（p = 0.029）。在倾向评分匹配对中，接受辅助化疗的患者与未接受辅助化疗的患者在OS方面无显著差异（p = 0.386）。接受辅助化疗的患者的FFR概率显著高于未接受辅助化疗的患者（p = 0.043）。对于以微乳头/实性为主型的患者，在多因素分析中，辅助化疗（p = 0.033）是FFR概率更高的显著预后因素。
辅助化疗是ⅠB期肺腺癌患者FFR概率的有利预后因素，特别是对于微乳头/实性为主型的患者。
