Department of Thoracic Surgery, Centre of Thoracic Minimally Invasive Surgery, Peking University People's Hospital, Beijing, China.
Eur J Cardiothorac Surg. 2019 Jun 1;55(6):1121-1129. doi: 10.1093/ejcts/ezy439.
Non-small-cell lung cancer (NSCLC) patients with ipsilateral pleural dissemination (M1a) are generally contraindicated for surgery. However, several small-sample studies have demonstrated that they might benefit from surgery. We investigated the effects of primary tumour resection on survival in these patients.
Stage IV NSCLC patients with ipsilateral pleural dissemination were identified from the US National Cancer Institute Surveillance, Epidemiology and End Results database entries from 2010 to 2015. Survival analysis was performed before and after matching. Multivariable regression models were built to identify prognostic factors.
Of the 5513 patients with ipsilateral pleural dissemination, 309 underwent primary tumour resection. In the entire cohort, surgery was associated with improved overall survival (OS) in both the unmatched and matched cohorts (both log rank, P < 0.001). In the surgery-recommended cohort, patients treated with surgery also had significantly longer OS before and after matching. Multivariable regression models showed that surgery was an independent favourable prognostic factor for OS [hazard ratio (HR) 0.56, 95% confidence interval (CI) 0.48-0.65; P < 0.001] and lung cancer-specific mortality (subhazard ratio 0.60, 95% CI 0.51-0.70; P < 0.001). Surgery was independently associated with improved survival in all subgroups except for those with pericardial effusion (P = 0.065) or N3 disease (P = 0.17). In the surgical cohort, patients who underwent lobe/bilobectomy had significantly better OS than those who underwent sublobar resection (log rank, P < 0.001).
Inclusion of primary tumour resection in multimodal therapy of NSCLC was associated with improved survival in selected patients with ipsilateral pleural dissemination, except for those with pericardial effusion or N3 disease.
患有同侧胸膜播散（M1a）的非小细胞肺癌（NSCLC）患者通常被认为不适合手术。然而，几项小样本研究表明，他们可能从手术中受益。我们研究了原发肿瘤切除对这些患者生存的影响。
从 2010 年至 2015 年美国国家癌症研究所监测、流行病学和最终结果数据库的记录中确定了患有同侧胸膜播散的 IV 期 NSCLC 患者。在匹配前后进行生存分析。建立多变量回归模型以确定预后因素。
在 5513 例同侧胸膜播散患者中，有 309 例接受了原发肿瘤切除术。在整个队列中，手术与未匹配和匹配队列的总生存（OS）改善相关（均对数秩，P<0.001）。在推荐手术的队列中，手术治疗的患者在匹配前后的 OS 也显著延长。多变量回归模型显示，手术是 OS 的独立有利预后因素[风险比（HR）0.56，95%置信区间（CI）0.48-0.65；P<0.001]和肺癌特异性死亡率（亚风险比 0.60，95%CI 0.51-0.70；P<0.001）。手术与所有亚组的生存改善相关，除了有心包积液（P=0.065）或 N3 疾病（P=0.17）的患者除外。在手术队列中，行肺叶/双肺叶切除术的患者的 OS 明显优于行亚肺叶切除术的患者（对数秩，P<0.001）。
在选择的同侧胸膜播散患者中，将原发肿瘤切除术纳入 NSCLC 的多模式治疗中与生存改善相关，除了有心包积液或 N3 疾病的患者除外。
