Prescrire Int. 2016 Dec;25(177):299-301.
About one-quarter of cases of non- small cell lung cancer are diagnosed sufficiently early, i.e. at stages I to lIlA, to envisage surgical resection. Despite this surgery, the prognosis remains poor. In 2016, what is the harm-benefit balance of chemotherapy in addition to surgical resection of early-stage non-small cell lung cancer? We con- ducted a review of the literature using the standard Prescrire methodology. In 38 trials including about 11 000 patients, the 5-year survival rate rose from 60% to 64% when surgery was followed by chemotherapy in patients who mainly had stage IB or I disease, and from 29% to 33% in patients with mainly stage Ill disease who also received radiation therapy. The chemo- therapy regimens used in most of these trials consisted of cisplatin plus a vinca alkaloid such as vinorelbine. In 15 trials including more than 2000 patients, most of whom had resectable stage IB, IIB or lIlA disease, platinum-based chemotherapy given before surgery raised the 5-year sur- vival rate from 40% without chemo- therapy to 45%. There are too few data to assess the impact of chemotherapy on sur- vival among patients who undergo surgery for stage IA disease. About two-thirds of patients who receive platinum-based chemotherapy experience serious adverse effects, and at least 1% of patients die from toxicity. The most common adverse effects are haematological disorders. Tyrosine kinase inhibitors and angiogenesis inhibitors have not been shown to improve survival among patients with resectable non-small cell lung cancer. Clinical guidelines published since 2010 recommend cisplatin-based chemotherapy for patients with resect- able stage IIB or lIlA disease. There is some disagreement concerning stage IB and IIA disease. In practice, clinical trials show that adjuvant chemotherapy improves the 5-year survival rate by a few percent- age points among patients who under- go surgical resection for non-small cell lung cancer. Adjuvant chemother- apy with cisplatin and a vinca alkaloid is thus a reasonable choice for surgi- cal patients (except those with a local- ised tumour measuring ≤ 3 cm), who accept its toxicity, with the hope of a slightly longer survival. It is also a reasonable option for patients to forgo chemotherapy.
约四分之一的非小细胞肺癌病例在足够早期被诊断出来，即处于I至IIIA期，可考虑手术切除。尽管进行了手术，预后仍然很差。2016年，早期非小细胞肺癌手术切除后再进行化疗的利弊平衡如何？我们使用标准的Prescrire方法对文献进行了综述。在38项试验中，涉及约11000名患者，对于主要为IB期或I期疾病的患者，手术后进行化疗，其5年生存率从60%提高到64%；对于主要为III期疾病且也接受放疗的患者，5年生存率从29%提高到33%。这些试验中大多数使用的化疗方案是顺铂加一种长春花生物碱，如长春瑞滨。在15项试验中，涉及2000多名患者，其中大多数患有可切除的IB期、IIB期或IIIA期疾病，术前给予铂类化疗使5年生存率从无化疗时的40%提高到45%。评估化疗对IA期疾病手术患者生存率影响的数据太少。接受铂类化疗的患者中约三分之二会出现严重不良反应，至少1%的患者死于毒性。最常见的不良反应是血液系统疾病。酪氨酸激酶抑制剂和血管生成抑制剂尚未显示能提高可切除非小细胞肺癌患者的生存率。自2010年以来发布的临床指南推荐对可切除的IIB期或IIIA期疾病患者进行基于顺铂的化疗。对于IB期和IIA期疾病存在一些分歧。在实践中，临床试验表明辅助化疗可使接受非小细胞肺癌手术切除的患者5年生存率提高几个百分点。因此，对于接受其毒性且希望生存时间稍长一点的手术患者（除肿瘤局限且直径≤3 cm者外），顺铂和长春花生物碱的辅助化疗是一个合理选择。对于患者放弃化疗也是一个合理的选择。
