Tandberg Daniel J, Kelsey Chris R, D'Amico Thomas A, Crawford Jeffrey, Chino Junzo P, Tong Betty C, Ready Neal E, Wright Ato
Department of Radiation Oncology, Duke University School of Medicine, Durham, NC.
Department of Radiation Oncology, Duke University School of Medicine, Durham, NC.
Clin Lung Cancer. 2017 Jul;18(4):e259-e265. doi: 10.1016/j.cllc.2016.11.008. Epub 2016 Nov 21.
The patterns of failure after resection of non-small-cell lung cancer (NSCLC) invading the chest wall are not well documented, and the role of adjuvant radiation therapy (RT) is unclear, prompting the present analysis.
The present institutional review board-approved study evaluated patients who had undergone surgery from 1995 to 2014 for localized NSCLC invading the chest wall. Patients with superior sulcus tumors were excluded. The clinical outcomes were estimated using the Kaplan-Meier method and compared using a log-rank test. The prognostic factors were assessed using a multivariate analysis, and the patterns of failure were scored.
Seventy-four patients were evaluated. Most patients had undergone lobectomy or pneumonectomy (85%) with en bloc chest wall resection (80%) and had pathologically node negative findings (81%). The surgical margins were positive in 10 patients (14%) and most commonly involved the chest wall (7 of 10). Adjuvant treatment included RT in 21 (28%) and chemotherapy in 28 (38%). A total of 24 local recurrences developed. The chest wall was a component of local disease recurrence in 19 of 24 cases (79%). The local control rate at 5 years for the entire population was 60% (95% confidence interval, 46%-74%). The local control rate was 74% with adjuvant RT versus 55% without RT (P = .43). On multivariate analysis, only resection less than lobectomy or pneumonectomy was associated with worse local control. The overall survival rate was 38% with RT versus 34% without RT (P = .59).
Positive surgical margins and local disease recurrence were common after resection of NSCLC invading the chest wall. The primary pattern of failure was local recurrence in the chest wall. Adjuvant RT was not associated with improved local control or survival.
侵犯胸壁的非小细胞肺癌（NSCLC）切除术后的失败模式尚无充分记录，辅助放疗（RT）的作用也不明确，因此进行了本分析。
本研究经机构审查委员会批准，评估了1995年至2014年因局限性侵犯胸壁的NSCLC接受手术的患者。排除肺上沟瘤患者。采用Kaplan-Meier法估计临床结局，并使用对数秩检验进行比较。通过多因素分析评估预后因素，并对失败模式进行评分。
共评估了74例患者。大多数患者接受了肺叶切除术或全肺切除术（85%），并整块切除胸壁（80%），病理检查淋巴结阴性（81%）。10例患者（14%）手术切缘阳性，最常见累及胸壁（10例中的7例）。辅助治疗包括21例（28%）接受放疗和28例（38%）接受化疗。共发生24例局部复发。24例中有19例（79%）胸壁是局部疾病复发的组成部分。整个人群的5年局部控制率为60%（95%置信区间，46%-74%）。辅助放疗组的局部控制率为74%，未放疗组为55%（P = 0.43）。多因素分析显示，只有小于肺叶切除术或全肺切除术的切除与较差的局部控制相关。放疗组的总生存率为38%，未放疗组为34%（P = 0.59）。
侵犯胸壁的NSCLC切除术后手术切缘阳性和局部疾病复发很常见。主要的失败模式是胸壁局部复发。辅助放疗与改善局部控制或生存率无关。
