1 Department of General Thoracic Surgery, Osaka University Graduate School of Medicine, Osaka, Japan.
2 Department of Radiation Oncology, Osaka University Graduate School of Medicine, Osaka, Japan.
Technol Cancer Res Treat. 2019 Jan 1;18:1533033819871327. doi: 10.1177/1533033819871327.
Information on the short- and long-term outcomes of induction chemoradiotherapy followed by surgery for cT3-4 non-small cell lung cancer is limited. We analyzed the short- and long-term outcomes of induction chemoradiotherapy followed by surgery for cT3-4 non-small cell lung cancer.
Patients with non-small cell lung cancer who underwent induction chemoradiotherapy followed by surgery for cT3-4 non-small cell lung cancer were retrospectively reviewed (initial treatment group, n = 31). Their results were compared to those patients who underwent surgery as an initial treatment during the same period (initial surgery group, n = 35).
Downstaging was achieved in 14 (45%) patients in the initial treatment group. R0 resection was achieved in 28 (90%) patients in the initial treatment group and 31 (88%) patients in the initial surgery group. The 90-day mortality rate was 3% in each group. Postoperative complications occurred in 16 (52%) patients in the initial treatment group and 13 (37%) patients in the initial surgery group. The 5-year overall survival rate of the initial treatment group was significantly higher than that of the initial surgery group (62.6% vs 43.5%, = .04). The 5-year overall survival rates of the initial treatment N0-1 group and the initial surgery N0-1 group were 88.9% and 49.3%, respectively; the difference was statistically significant ( = .02). Multivariate analysis using 4 factors (age [≤65 vs >65], cN [cN0-1 vs cN2], general condition [chemoradiotherapy fit vs chemoradiotherapy unfit], and treatment mode [induction chemoradiotherapy followed by surgery vs surgery as an initial treatment]) revealed that treatment mode (induction chemoradiotherapy followed by surgery) and cN status (cN0-1) were significantly associated with good overall survival and disease-free survival.
Induction chemoradiotherapy followed by surgery for cT3-4 non-small cell lung cancer could be performed with an acceptable degree of surgical risk. At present, it is thought to be one of the reasonable treatment approaches for selected patients with cT3-4 disease, even those with a cN0-1 status.
诱导放化疗后手术治疗 cT3-4 期非小细胞肺癌的短期和长期结果的信息有限。我们分析了诱导放化疗后手术治疗 cT3-4 期非小细胞肺癌的短期和长期结果。
回顾性分析了接受诱导放化疗后手术治疗 cT3-4 期非小细胞肺癌的患者（初始治疗组，n=31）。将其结果与同期接受手术作为初始治疗的患者（初始手术组，n=35）进行比较。
初始治疗组中 14 例（45%）患者降期。初始治疗组中 28 例（90%）患者达到 R0 切除，初始手术组中 31 例（88%）患者达到 R0 切除。两组 90 天死亡率均为 3%。初始治疗组 16 例（52%）患者发生术后并发症，初始手术组 13 例（37%）患者发生术后并发症。初始治疗组的 5 年总生存率明显高于初始手术组（62.6%比 43.5%，P=0.04）。初始治疗 N0-1 组和初始手术 N0-1 组的 5 年总生存率分别为 88.9%和 49.3%，差异有统计学意义（P=0.02）。使用 4 个因素（年龄[≤65 岁与＞65 岁]、cN[cN0-1 与 cN2]、一般情况[放化疗适应与放化疗不适应]和治疗方式[诱导放化疗后手术与手术作为初始治疗]）的多因素分析显示，治疗方式（诱导放化疗后手术）和 cN 状态（cN0-1）与良好的总生存和无病生存显著相关。
cT3-4 期非小细胞肺癌诱导放化疗后手术可在可接受的手术风险下进行。目前，对于 cT3-4 期疾病，甚至对于 cN0-1 期患者，被认为是一种合理的治疗方法。
