Thoracic Surgery Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY.
Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY.
J Thorac Cardiovasc Surg. 2019 Feb;157(2):743-753.e3. doi: 10.1016/j.jtcvs.2018.09.098. Epub 2018 Oct 10.
Comparative survival between neoadjuvant chemotherapy and adjuvant chemotherapy for patients with cT2-4N0-1M0 non-small cell lung cancer has not been extensively studied.
Patients with cT2-4N0-1M0 non-small cell lung cancer who received platinum-based chemotherapy were retrospectively identified. Exclusion criteria included stage IV disease, induction radiotherapy, and targeted therapy. The primary end point was disease-free survival. Secondary end points were overall survival, chemotherapy tolerance, and ability of Response Evaluation Criteria In Solid Tumors response to predict survival. Survival was estimated using the Kaplan-Meier method, compared using the log-rank test and Cox proportional hazards models, and stratified using matched pairs after propensity score matching.
In total, 330 patients met the inclusion criteria (n = 92/group after propensity-score matching; median follow-up, 42 months). Five-year disease-free survival was 49% (95% confidence interval, 39-61) for neoadjuvant chemotherapy versus 48% (95% confidence interval, 38-61) for adjuvant chemotherapy (P = .70). On multivariable analysis, disease-free survival was not associated with neoadjuvant chemotherapy or adjuvant chemotherapy (hazard ratio, 1.1; 95% confidence interval, 0.64-1.90; P = .737), nor was overall survival (hazard ratio, 1.21; 95% confidence interval, 0.63-2.30; P = .572). The neoadjuvant chemotherapy group was more likely to receive full doses and cycles of chemotherapy (P = .014/0.005) and had fewer grade 3 or greater toxicities (P = .001). Response Evaluation Criteria In Solid Tumors response to neoadjuvant chemotherapy was associated with disease-free survival (P = .035); 15% of patients receiving neoadjuvant chemotherapy (14/92) had a major pathologic response.
Timing of chemotherapy, before or after surgery, is not associated with an improvement in overall or disease-free survival among patients with cT2-4N0-1M0 non-small cell lung cancer who undergo complete surgical resection.
新辅助化疗与辅助化疗在 cT2-4N0-1M0 期非小细胞肺癌患者中的生存比较尚未得到广泛研究。
回顾性分析接受铂类化疗的 cT2-4N0-1M0 期非小细胞肺癌患者。排除标准包括 IV 期疾病、诱导放疗和靶向治疗。主要终点是无病生存。次要终点是总生存、化疗耐受性和实体瘤反应评价标准的反应能力预测生存。采用 Kaplan-Meier 法估计生存，对数秩检验和 Cox 比例风险模型比较，倾向性评分匹配后分层匹配对。
共 330 例患者符合纳入标准（n=92/组，经倾向性评分匹配后；中位随访时间为 42 个月）。新辅助化疗组 5 年无病生存率为 49%（95%置信区间，39-61），辅助化疗组为 48%（95%置信区间，38-61）（P=0.70）。多变量分析显示，无病生存率与新辅助化疗或辅助化疗无关（风险比，1.1；95%置信区间，0.64-1.90；P=0.737），总生存率也无关（风险比，1.21；95%置信区间，0.63-2.30；P=0.572）。新辅助化疗组更有可能接受全剂量和全周期化疗（P=0.014/0.005），且毒性反应 3 级或以上的发生率较低（P=0.001）。新辅助化疗的实体瘤反应评价标准与无病生存率相关（P=0.035）；新辅助化疗组 15%（14/92）的患者有主要病理缓解。
在完全手术切除的 cT2-4N0-1M0 期非小细胞肺癌患者中，化疗时机（手术前或手术后）与总生存或无病生存的改善无关。
