辅助治疗对非小细胞肺癌手术后不确定切缘患者生存的影响。
The influence of adjuvant therapy on survival in patients with indeterminate margins following surgery for non-small cell lung cancer.
机构信息
Division of Cardiovascular and Thoracic Surgery, Department of Surgery, Duke University Medical Center, Durham, NC.
Division of Cardiovascular and Thoracic Surgery, Department of Surgery, Duke University Medical Center, Durham, NC.
出版信息
J Thorac Cardiovasc Surg. 2020 May;159(5):2030-2040.e4. doi: 10.1016/j.jtcvs.2019.09.075. Epub 2019 Sep 30.
BACKGROUND
The significance of indeterminate margins following surgery for non-small cell lung cancer (NSCLC) is unknown. We evaluated the influence of adjuvant therapy on survival in patients whose cancer showed indeterminate margins.
METHODS
Patients whose cancer showed indeterminate margins following surgery for NSCLC were identified in the National Cancer Database between 2004 and 2015, and stratified by receipt of adjuvant treatment. The primary outcome was overall survival, which was evaluated with multivariable Cox proportional hazards.
RESULTS
Indeterminate margins occurred in 0.31% of 232,986 patients undergoing surgery for NSCLC and was associated with worse survival compared with margin negative resection (adjusted hazard ratio, 1.53; 95% confidence interval, 1.40-1.67). Anatomic resection was protective against the finding of indeterminate margins in logistic regression. Amongst 553 patients with indeterminate margins, 343 (62%) received no adjuvant therapy, 96 (17%) received adjuvant chemotherapy, 33 (6%) received adjuvant radiation, and 81 (15%) received adjuvant chemoradiation. Any mode of adjuvant therapy was not associated with improved survival compared with no further treatment.
CONCLUSIONS
The finding of indeterminate margins is reported in 0.31% of patients undergoing curative-intent surgery for NSCLC. This was associated with worse overall survival compared with complete resection and not mitigated by adjuvant therapy. The risks and benefits of adjuvant therapy should be carefully considered for patients with indeterminate margins after surgery for NSCLC.
背景
非小细胞肺癌（NSCLC）手术后切缘不确定的意义尚不清楚。我们评估了辅助治疗对癌症切缘不确定的患者生存的影响。
方法
在 2004 年至 2015 年间，国家癌症数据库中确定了 NSCLC 手术后癌症切缘不确定的患者，并按接受辅助治疗进行分层。主要结局是总生存，通过多变量 Cox 比例风险进行评估。
结果
232986 例接受 NSCLC 手术的患者中，有 0.31%的患者切缘不确定，与切缘阴性切除相比，其生存率较差（调整后的危险比为 1.53；95%置信区间为 1.40-1.67）。在逻辑回归中，解剖性切除术可预防切缘不确定的发现。在 553 例切缘不确定的患者中，343 例（62%）未接受辅助治疗，96 例（17%）接受辅助化疗，33 例（6%）接受辅助放疗，81 例（15%）接受辅助放化疗。与未进一步治疗相比，任何辅助治疗模式均未改善生存。
结论
在接受根治性手术治疗 NSCLC 的患者中，有 0.31%的患者报告了切缘不确定。与完全切除相比，这与总体生存率较差相关，且不能通过辅助治疗改善。对于 NSCLC 手术后切缘不确定的患者，应仔细考虑辅助治疗的风险和获益。
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