Department of Surgery, NorthShore University Health System, Evanston, Illinois; Department of Surgery, University of Chicago Pritzker School of Medicine, Chicago, Illinois.
Department of Surgery, University of Chicago Pritzker School of Medicine, Chicago, Illinois.
Ann Thorac Surg. 2018 Apr;105(4):1008-1016. doi: 10.1016/j.athoracsur.2017.10.056. Epub 2018 Feb 14.
For operable patients with clinical stage IIIA non-small cell lung cancer, the optimum neoadjuvant treatment strategy remains unclear. Our aim was to compare perioperative and long-term outcomes for patients receiving neoadjuvant chemoradiotherapy (NCRT) versus neoadjuvant chemotherapy (NCT) alone.
We queried the National Cancer Database to identify all patients with N2 and either T1-T2 non-small cell lung cancer who received either NCRT or NCT followed by lobectomy between 2006 and 2012. Patients with T3 tumors were excluded. A propensity match analysis was performed incorporating preoperative variables, and the incidence of postoperative complications, pathologic downstaging, and long-term survival were compared.
In all, 1,936 patients met criteria, 745 NCT and 1,191 NCRT. The NCRT patients were younger, less likely to be treated at an academic medical center, and more likely to have adenocarcinoma. After propensity matching, patients in the NCT group showed lower 30-day mortality (1.3% versus 2.9%) and 90-day mortality (2.9% versus 6.0%), and were more likely to undergo a minimally invasive resection (25.7% versus 14.1%). The NCRT patients were more likely to have a pathologic complete response (14.2% versus 4.0%) and to be N0 at the time of resection (45.2% versus 38.7%). In the multivariable analysis, NCRT patients were at a greater risk of mortality than NCT patients (hazard ratio 1.18, 95% confidence interval: 1.03 to 1.36).
In our cohort, combined neoadjuvant chemotherapy and radiation therapy was associated with improved pathologic downstaging but showed increased perioperative mortality with no improvement in long-term overall survival. For stage IIIA patients with smaller tumors without local invasion, chemotherapy alone may be the preferred neoadjuvant treatment.
对于可手术的 IIIA 期非小细胞肺癌患者，最佳新辅助治疗策略仍不清楚。我们的目的是比较接受新辅助放化疗（NCRT）与单纯新辅助化疗（NCT）的患者的围手术期和长期结果。
我们在国家癌症数据库中查询了 2006 年至 2012 年间接受 NCRT 或 NCT 后行肺叶切除术的 N2 和 T1-T2 非小细胞肺癌患者的所有患者。排除 T3 肿瘤患者。进行了倾向匹配分析，纳入了术前变量，并比较了术后并发症、病理降期和长期生存的发生率。
共有 1936 例患者符合标准，745 例接受 NCT，1191 例接受 NCRT。NCRT 患者年龄较小，较少在学术医疗中心接受治疗，且更可能患有腺癌。在倾向匹配后，NCT 组患者的 30 天死亡率（1.3%比 2.9%）和 90 天死亡率（2.9%比 6.0%）较低，更有可能接受微创手术（25.7%比 14.1%）。NCRT 患者更可能出现病理完全缓解（14.2%比 4.0%）和在切除时为 N0（45.2%比 38.7%）。在多变量分析中，NCRT 患者的死亡率高于 NCT 患者（风险比 1.18，95%置信区间：1.03 至 1.36）。
在我们的队列中，联合新辅助化疗和放疗与改善病理降期相关，但围手术期死亡率增加，而长期总体生存率无改善。对于肿瘤较小且无局部侵犯的 IIIA 期患者，单独化疗可能是首选的新辅助治疗。
