Department of Thoracic Surgery, Uludağ University, School of Medicine, Bursa, Turkey.
Eur J Cardiothorac Surg. 2019 Sep 1;56(3):604-611. doi: 10.1093/ejcts/ezz044.
Prognosis for patients with non-small-cell lung cancer (NSCLC) who, after neoadjuvant/induction and surgery, have a pathological complete response (pCR) is expected to be improved. However, the place of the pCR patients in the context of the tumour, lymph node and metastasis (TNM) staging system is still not defined. The aim of this study is to investigate the long-term survival of NSCLC patients with pCR and to find their appropriate staging category within the TNM staging system.
We retrospectively reviewed the prospectively recorded data of 1076 patients undergoing surgery (segmentectomy or more) for NSCLC between 1996 and 2016. Patients were divided into 2 groups. Group 1: clinical early-stage patients who underwent direct surgical resection (n = 660); group 2: patients who received neoadjuvant/induction treatment before surgical resection for locally advanced NSCLC (n = 416). Morbidity, mortality, survival rates and prognostic factors were analysed and compared.
Postoperative histopathological evaluation revealed pCR in 72 (17%) patients in group 2. Overall 5-year survival was 58.7% (group 1 = 62.3%, group 2 = 52.8%, P = 0.001). Of note, 5-year survival was 72.2% for pCRs. In addition, 5-year survival for stage 1a disease was 82.6% in group 1 and 63.2% in group 2 (P = 0.008); 70.3% in group 1 and 60.5% in group 2 for stage 1b (P = 0.08). Patients with stage II had a 5-year survival of 53.9% in group 1 and 51.1% in group 2 (P = 0.36).
This study shows that patients with locally advanced NSCLC developing a pCR after neoadjuvant/induction treatment have the best long-term survival and survival similar that of to stage Ib patients.
新辅助/诱导治疗和手术治疗后病理完全缓解（pCR）的非小细胞肺癌（NSCLC）患者的预后预计会得到改善。然而，pCR 患者在肿瘤、淋巴结和转移（TNM）分期系统中的位置尚未确定。本研究旨在探讨 NSCLC 患者 pCR 的长期生存情况，并找到其在 TNM 分期系统中的合适分期类别。
我们回顾性分析了 1996 年至 2016 年间接受手术（肺段切除术及以上）治疗的 1076 例 NSCLC 患者的前瞻性记录数据。患者分为 2 组。第 1 组：直接接受手术切除的临床早期患者（n=660）；第 2 组：接受新辅助/诱导治疗后行局部晚期 NSCLC 手术切除的患者（n=416）。分析比较两组患者的发病率、死亡率、生存率和预后因素。
术后组织病理学评估显示，第 2 组中有 72 例（17%）患者出现 pCR。总体 5 年生存率为 58.7%（第 1 组为 62.3%，第 2 组为 52.8%，P=0.001）。值得注意的是，pCR 患者的 5 年生存率为 72.2%。此外，第 1 组 1a 期疾病的 5 年生存率为 82.6%，第 2 组为 63.2%（P=0.008）；第 1 组 1b 期为 70.3%，第 2 组为 60.5%（P=0.08）。第 2 组 2 期患者的 5 年生存率为 53.9%，第 1 组为 51.1%（P=0.36）。
本研究表明，接受新辅助/诱导治疗后发生 pCR 的局部晚期 NSCLC 患者具有最佳的长期生存，与 1b 期患者的生存相似。
