The University of Tokyo, Tokyo, Japan.
The University of Tokyo, Tokyo, Japan.
Ann Thorac Surg. 2019 Dec;108(6):1671-1677. doi: 10.1016/j.athoracsur.2019.06.074. Epub 2019 Aug 14.
Patients with lung cancer with a history of treatment often undergo curative surgical resection. However, the impact of previous cancer treatment on the outcome of lung cancer remains unclear.
We conducted a retrospective study of patients who underwent curative resection for non-small cell lung cancer between 1998 and 2011. We collected clinicopathologic data and patients were divided into groups by previous history of cancer treatment. Comparisons between groups, estimation of survival rates, and multivariate analyses were performed. Propensity score matching was used to create cohorts with reduced bias.
Of 878 patients, 196 (22.3%) had previous extrathoracic malignancies, and stage I lung cancer was more frequent in this group (P < .001). In multivariate analysis of the whole cohort, older patients, men, non-adenocarcinoma histologic type, more advanced pathologic stage of lung cancer, interstitial pneumonia, and previous extrathoracic malignancies were associated with appreciably worse prognosis. When propensity score matched cohorts were compared, prognosis was significantly worse in patients with previous extrathoracic malignancies than patients without (5-year survival rates, 75.3% vs 82.7%; P = .009), although recurrence was not frequently seen (5-year recurrence-free rates, 78.7% vs 83.0%; P = .491).
Because treatment history of extrathoracic malignancy was not associated with postsurgical lung cancer recurrence, proposing curative resection could be justifiable if the previous cancer is deemed cured or controlled. However, the results showing that patients with previous cancer history have a worse survival rate than patients without should be taken into account when curative surgery is considered.
有治疗史的肺癌患者常接受根治性手术切除。然而，既往癌症治疗对肺癌结局的影响尚不清楚。
我们对 1998 年至 2011 年间接受非小细胞肺癌根治性切除术的患者进行了回顾性研究。收集临床病理数据，并根据既往癌症治疗史将患者分为两组。对两组进行比较、生存率估计和多变量分析。采用倾向评分匹配法创建降低偏倚的队列。
在 878 例患者中，有 196 例（22.3%）有胸外恶性肿瘤既往史，且该组中Ⅰ期肺癌更为常见（P<.001）。在全队列的多变量分析中，老年、男性、非腺癌组织学类型、更晚期的肺癌病理分期、间质性肺炎和胸外恶性肿瘤既往史与预后明显较差相关。当比较倾向评分匹配的队列时，与无胸外恶性肿瘤既往史的患者相比，有胸外恶性肿瘤既往史的患者预后显著更差（5 年生存率，75.3%比 82.7%；P=.009），尽管复发并不常见（5 年无复发生存率，78.7%比 83.0%；P=.491）。
由于胸外恶性肿瘤治疗史与术后肺癌复发无关，如果先前癌症被认为已治愈或得到控制，提出根治性切除术是合理的。然而，在考虑根治性手术时，应考虑到有既往癌症史的患者生存率比无既往癌症史的患者更差的结果。
