Wakeam Elliot, Giuliani Meredith, Leighl Natasha B, Finlayson Samuel R G, Varghese Thomas K, Darling Gail E
Division of General Surgery, Department of Surgery, University of Toronto, Toronto, Ontario, Canada; Division of Thoracic Surgery, Department of Surgery, University of Toronto, Toronto, Ontario, Canada.
Department of Radiation Oncology, University of Toronto, Toronto, Ontario, Canada; Radiation Medicine Program Princess Margaret Cancer Centre, Toronto, Ontario, Canada.
Ann Thorac Surg. 2017 May;103(5):1647-1653. doi: 10.1016/j.athoracsur.2016.11.039. Epub 2017 Mar 3.
Adjuvant mediastinal radiotherapy (AMR) is used after surgical resection for patients with small cell lung cancer (SCLC), but data guiding its use are scant. We sought to examine whether AMR was associated with an improvement in survival for resected SCLC patients and to define subpopulations who should be selected for AMR.
Patients undergoing lobectomy, pneumonectomy, and sublobar resection for SCLC were identified in the National Cancer Database (2004 to 2013). Kaplan-Meier survival curves and Cox proportional hazards were used to evaluate associations between AMR and survival. Hazard ratios were adjusted for patient comorbidity, demographics, tumor characteristics, such as stage, grade, histology, and margin status, and receipt of adjuvant chemotherapy.
We identified 3,101 patients. Those receiving AMR were younger, more likely to have greater pathologic T and N stage, to undergo sublobar resection, and to have a positive margin. Kaplan-Meier curves showed better median survival for patients with pN1 or pN2 disease who received AMR. After adjustment, Cox models showed AMR was associated with a lower risk of death for pN1 (hazard ratio, 0.79; 95% confidence interval, 0.63 to 1.00; p = 0.05) and pN2 (hazard ratio, 0.60; 95% confidence interval, 0.48 to 0.75; p < 0.0001). In the overall cohort, AMR was not associated with better survival in node-negative patients. AMR was, however, associated with improved survival for patients receiving sublobar resection (hazard ratio, 0.72; 95% confidence interval, 0.57 to 0.90; p = 0.004).
AMR is associated with longer survival for node-positive patients after resection for SCLC, especially those with pN2. AMR may also be associated with longer survival in patients undergoing sublobar resections.
辅助性纵隔放疗（AMR）用于小细胞肺癌（SCLC）患者手术切除后，但指导其应用的数据较少。我们试图研究AMR是否与SCLC切除术后患者生存率的提高相关，并确定应选择接受AMR的亚组人群。
在国家癌症数据库（2004年至2013年）中识别接受SCLC肺叶切除术、全肺切除术和肺叶下切除术的患者。采用Kaplan-Meier生存曲线和Cox比例风险模型评估AMR与生存率之间的关联。风险比针对患者合并症、人口统计学特征、肿瘤特征（如分期、分级、组织学和切缘状态）以及辅助化疗的接受情况进行了调整。
我们识别出3101例患者。接受AMR的患者更年轻，更有可能具有更高的病理T和N分期，接受肺叶下切除术，且切缘阳性。Kaplan-Meier曲线显示，接受AMR的pN1或pN2疾病患者的中位生存期更好。调整后，Cox模型显示，AMR与pN1（风险比，0.79；95%置信区间，0.63至1.00；p = 0.05）和pN2（风险比，0.60；95%置信区间，0.48至0.75；p < 0.0001）患者的死亡风险较低相关。在整个队列中，AMR与淋巴结阴性患者的生存率提高无关。然而，AMR与接受肺叶下切除术的患者生存率提高相关（风险比，0.72；95%置信区间，0.57至0.90；p = 0.004）。
AMR与SCLC切除术后淋巴结阳性患者的生存期延长相关，尤其是pN2患者。AMR也可能与接受肺叶下切除术的患者生存期延长相关。
