Allegheny Health Network Cancer Institute, Division of Radiation Oncology, Pittsburgh, PA, United States.
Allegheny Health Network, Department of Internal Medicine, Pittsburgh, PA, United States.
Lung Cancer. 2019 Feb;128:127-133. doi: 10.1016/j.lungcan.2018.12.022. Epub 2018 Dec 24.
Recent retrospective studies have demonstrated mixed results regarding the histologic association of squamous cell carcinoma (SCC) with reduced overall survival in patients with early-stage non-small cell lung cancer (ES-NSCLC) treated with stereotactic ablative radiotherapy (SABR).
We queried the National Cancer Database (NCDB) for ES-NSCLC (T1-2N0, Stage I-IIA) patients with SCC or adenocarcinoma (ADC) treated with SABR. Univariable and multivariable analyses identified characteristics predictive of overall survival. Cox proportional hazard ratios with propensity adjustment were used to mitigate indication bias between the two histologic arms.
Ultimately 15,110 ES-NSCLC patients with either ADC (n = 8,924) or SCC (n = 6,186) were eligible for analysis. Univariable analysis demonstrated a median overall survival of 44 months and 33 months (p < 0.0001) and 5-year overall survival of 36% and 24% (p < 0.0001) in patients diagnosed with ADC and SCC, respectively. SCC histology, remained an independent predictor of worse survival on propensity score matched multivariable comparison (p < 0.0001). Patients with SCC were more likely to have T2 lesions and poorly differentiated grade. Females, African American race, T1 lesions, and age <75 years were also associated with improved survival. Conclusion SCC histology was an independent prognosticator of worse survival in patients with ES-NSCLC treated with SABR, thus corroborating the results of previous studies. Randomized, prospective studies are needed to further validate these findings.
最近的回顾性研究表明，在接受立体定向消融放疗（SABR）治疗的早期非小细胞肺癌（ES-NSCLC）患者中，鳞状细胞癌（SCC）与总生存降低之间存在混杂的组织学关联。
我们在国家癌症数据库（NCDB）中查询了接受 SABR 治疗的 ES-NSCLC（T1-2N0，I-IIA 期）患者的 SCC 或腺癌（ADC）病例。单变量和多变量分析确定了预测总生存的特征。采用倾向评分调整的 Cox 比例风险比来减轻两种组织学臂之间的指示性偏倚。
最终，15110 名患有 ADC（n=8924）或 SCC（n=6186）的 ES-NSCLC 患者符合分析条件。单变量分析显示，ADC 和 SCC 组的中位总生存时间分别为 44 个月和 33 个月（p<0.0001），5 年总生存率分别为 36%和 24%（p<0.0001）。在倾向评分匹配的多变量比较中，SCC 组织学仍然是生存较差的独立预测因素（p<0.0001）。SCC 患者更有可能患有 T2 病变和低分化等级。女性、非裔美国人种族、T1 病变和年龄<75 岁也与生存改善相关。结论：SCC 组织学是接受 SABR 治疗的 ES-NSCLC 患者生存较差的独立预后因素，这与之前的研究结果一致。需要进行随机、前瞻性研究来进一步验证这些发现。
