Department of Thoracic Surgery, National Cancer Center Hospital East, Kashiwa, Chiba, Japan.
Department of Thoracic Oncology, National Cancer Center Hospital East, Kashiwa, Chiba, Japan.
Eur J Cardiothorac Surg. 2017 Sep 1;52(3):522-528. doi: 10.1093/ejcts/ezx127.
Since survival after postoperative non-small-cell lung cancer (NSCLC) recurrence is extremely poor, the long-term post-recurrence outcomes are not well understood. The purpose of this study was to evaluate the long-term post-recurrence outcomes and clarify who are possibly 'cured' in recent clinical practice.
We reviewed the medical records of 635 patients who developed postoperative recurrence until 2012 after R0 resection for pathological Stage IA-IIIA NSCLC between 1993 and 2006. Factors associated with post-recurrence survival (PRS) and the characteristics of the long-term (≥5 years) survivors were analysed retrospectively.
The 5-year PRS rate of all 635 patients was 13%. Multivariable analysis revealed that female [hazard ratio (HR) = 0.78], adenocarcinoma (HR = 0.77), locoregional (only) recurrence (HR = 0.59) and longer recurrence-free survival (HR = 0.99) were favourably associated with PRS. A total of 51 patients achieved 5-year PRS; however, 32 (63%) were cancer-bearing patients in their fifth post-recurrent year who were mainly treated by epidermal growth factor receptor-tyrosine kinase inhibitor (EGFR-TKI). Subsequent PRS curves for cancer-controlled and cancer-bearing groups were different (8-year PRS: 94% vs 31%, P = 0.003). Among 19 cancer-controlled patients in their fifth post-recurrent year, 17 (89%) patients initially received radical local therapy for their recurrence.
Two-thirds of 5-year survivors after postoperative NSCLC recurrence had a cancer-bearing status and showed deteriorated subsequent survival. Curability of postoperative NSCLC recurrence should be evaluated in terms of the 'cancer-controlled' status, and 'cured' population is included in the patients who are 'cancer controlled' at the fifth post-recurrent year.
由于术后非小细胞肺癌（NSCLC）复发后的生存时间极短，因此对长期复发后结局的了解并不清楚。本研究旨在评估长期复发后的结局，并明确在当前临床实践中哪些患者可能“治愈”。
我们回顾了 1993 年至 2006 年间因病理分期为ⅠA-ⅢA 期 NSCLC 而行 R0 切除术后至 2012 年发生术后复发的 635 例患者的病历资料。回顾性分析与复发后生存（PRS）相关的因素及长期（≥5 年）生存者的特征。
635 例患者的 5 年 PRS 率为 13%。多变量分析显示，女性（HR=0.78）、腺癌（HR=0.77）、局部区域（仅）复发（HR=0.59）和更长的无复发生存时间（HR=0.99）与 PRS 呈正相关。共有 51 例患者达到了 5 年 PRS，但在第 5 个复发年后，其中 32 例（63%）为癌症带瘤患者，主要接受表皮生长因子受体酪氨酸激酶抑制剂（EGFR-TKI）治疗。癌症控制和带瘤生存两组的后续 PRS 曲线不同（8 年 PRS：94% vs 31%，P=0.003）。在第 5 个复发年后的 19 例癌症控制患者中，17 例（89%）患者最初因复发接受了根治性局部治疗。
术后 NSCLC 复发后 5 年生存者中有 2/3 为带瘤生存，且随后的生存恶化。术后 NSCLC 复发的可治愈性应根据“癌症控制”状态进行评估，将第 5 个复发年后“治愈”的患者纳入“癌症控制”人群中。
