Kim Hong Kwan, Cho Jong Ho, Choi Yong Soo, Zo Jae Ill, Shim Young Mog, Park Keunchil, Ahn Myung-Ju, Ahn Yong Chan, Kim Kwhanmien, Kim Jhingook
Department of Thoracic and Cardiovascular Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea.
Division of Hematology-Oncology, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea.
Lung Cancer. 2016 Jun;96:56-62. doi: 10.1016/j.lungcan.2016.03.016. Epub 2016 Mar 29.
The objective of this study was to evaluate the treatment outcomes and prognostic factors of neoadjuvant concurrent chemoradiotherapy (CCRT) followed by surgical resection for non-small cell lung cancer (NSCLC) with N2 disease.
A retrospective review of patients with N2 disease who underwent neoadjuvant CCRT followed by surgery at our institution was performed and multivariate Cox regression analysis was used to determine the factors associated with survival outcomes.
From 1997 to 2013, 574 patients underwent curative-intent surgery after neoadjuvant CCRT for NSCLC with N2 disease. The mean age was 59 years (444 men, 77%). The extent of surgery included lobectomy in 418 patients (73%), pneumonectomy in 73 (13%), and sleeve resection in 25 (4.3%). Complete resection was obtained in 543 patients (95%). Postoperative complications and in-hospital mortality occurred in 199 patients (35%) and 21 (3.7%), respectively. Pathologic complete response was achieved in 72 patients (13%) and 304 (53%) experienced mediastinal clearance. With a mean follow-up of 36 months, median overall survival (OS) and recurrence-free survival (RFS) were 56 months and 18 months, respectively. The 5-year OS rates were 61% in ypN0, 49% in ypN1, and 35% in ypN2 (p=0.001). The 5-year RFS rates were 45% in ypN0, 23% in ypN1, and 17% in ypN2 (p<0.001). Older age, advanced pT stage, persistent N2, large cell carcinoma, and pneumonectomy were independent prognostic factors associated with worse OS and poorer RFS.
Neoadjuvant CCRT followed by surgery could be performed with acceptable early postoperative outcomes, satisfactory local control, and encouraging long-term survival. Care should be taken in selecting patients when necessitating pneumonectomy after neoadjuvant CCRT. Further efforts to improve outcomes in patients with persistent N2 disease are required.
本研究旨在评估新辅助同步放化疗（CCRT）后行手术切除治疗N2期非小细胞肺癌（NSCLC）的治疗效果及预后因素。
对我院接受新辅助CCRT后行手术治疗的N2期患者进行回顾性分析，并采用多因素Cox回归分析确定与生存结局相关的因素。
1997年至2013年，574例N2期NSCLC患者在新辅助CCRT后接受了根治性手术。平均年龄为59岁（444例男性，占77%）。手术范围包括418例（73%）肺叶切除术、73例（13%）全肺切除术和25例（4.3%）袖状切除术。543例（95%）患者实现了完全切除。术后并发症和院内死亡率分别发生在199例（35%）和21例（3.7%）患者中。72例（13%）患者达到病理完全缓解，304例（53%）患者实现纵隔清扫。平均随访36个月，中位总生存期（OS）和无复发生存期（RFS）分别为56个月和18个月。ypN0患者的5年OS率为61%，ypN1患者为49%，ypN2患者为35%（p = 0.001）。ypN0患者的5年RFS率为45%，ypN1患者为23%，ypN2患者为17%（p < 0.001）。年龄较大、pT分期较晚、持续N2、大细胞癌和全肺切除术是与较差OS和RFS相关的独立预后因素。
新辅助CCRT后行手术治疗可获得可接受的早期术后结局、满意的局部控制和令人鼓舞的长期生存。新辅助CCRT后需要行全肺切除术时，应谨慎选择患者。需要进一步努力改善持续N2期患者的治疗结局。
