提出一个对接受肺转移瘤切除术的患者总生存有意义的替代终点：局部治疗失败时间。
Proposal of a Useful Surrogate Endpoint of the Overall Survival in Patients Undergoing Pulmonary Metastasectomy: The Time to Local Therapy Failure.
机构信息
Department of General Thoracic Surgery, Osaka University Graduate School of Medicine, L5-2-2 Yamadaoka, Suita, Osaka, 565-0871, Japan.
Department of Mathematical Health Science, Osaka University Graduate School of Medicine, Suita, Japan.
出版信息
World J Surg. 2019 Oct;43(10):2640-2646. doi: 10.1007/s00268-019-05071-2.
BACKGROUND
A recent study demonstrated remarkable discrepancy between the relapse-free survival (RFS) and overall survival (OS) after pulmonary metastasectomy (PM) in the current era. As the RFS may not be a suitable parameter after PM, a more suitable parameter is needed for PM as a surrogate marker for OS.
METHODS
A total of 134 consecutive patients who underwent PM were retrospectively analyzed. In the present study, we introduced a new endpoint, time to local treatment failure (TLTF). This endpoint was defined as the time interval between the first PM and the first untreatable recurrence by local treatment with curative intent or death due to any cause. We analyzed the correlation between the RFS and OS and between the TLTF and OS to validate whether or not the TLTF is a better parameter than the RFS after PM.
RESULTS
Thus far, 78 patients have experienced relapse. Of these, 37 patients (47%) underwent local therapy with curative intent, 29 of whom are alive without local treatment failure. The 5-year OS, RFS and TLTF were 70.9%, 36.5%, and 57.6%, respectively. The concordance proportions for the RFS and OS and for the TLTF and OS were 0.634 and 0.851 for all patients, respectively. The Spearman's rank correlation coefficient for the RFS and OS was 0.639, while that for the TLTF and OS was 0.875.
CONCLUSIONS
The TLTF may be a good surrogate parameter for the OS after PM in the current era.
背景
最近的一项研究表明，在当前时代，肺转移瘤切除术（PM）后的无复发生存率（RFS）和总生存率（OS）之间存在显著差异。由于 RFS 可能不是 PM 后的合适参数，因此需要一个更合适的参数作为 PM 的替代标志物来预测 OS。
方法
回顾性分析了 134 例连续接受 PM 的患者。在本研究中，我们引入了一个新的终点，即局部治疗失败时间（TLTF）。该终点定义为首次 PM 与首次因局部治疗（有治愈意图）而无法治疗的复发或任何原因导致的死亡之间的时间间隔。我们分析了 RFS 与 OS 之间以及 TLTF 与 OS 之间的相关性，以验证 TLTF 是否是 PM 后比 RFS 更好的参数。
结果
迄今为止，78 例患者出现复发。其中，37 例（47%）接受了有治愈意图的局部治疗，其中 29 例患者在没有局部治疗失败的情况下存活。5 年 OS、RFS 和 TLTF 分别为 70.9%、36.5%和 57.6%。所有患者的 RFS 和 OS 以及 TLTF 和 OS 的一致性比例分别为 0.634 和 0.851。RFS 和 OS 的 Spearman 秩相关系数为 0.639，而 TLTF 和 OS 的 Spearman 秩相关系数为 0.875。
结论
TLTF 可能是当前时代 PM 后 OS 的一个良好替代参数。
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