Yun Jae Kwang, Bok Jin San, Lee Geun Dong, Kim Hyeong Ryul, Kim Yong-Hee, Kim Dong Kwan, Park Seung-Il, Choi Sehoon
Department of Thoracic and Cardiovascular Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea.
Department of Thoracic and Cardiovascular Surgery, Chungnam National University Hospital, Daejon, Republic of Korea.
Eur J Cardiothorac Surg. 2020 Jul 1;58(1):59-69. doi: 10.1093/ejcts/ezaa042.
Although the standard treatment for pathological N2 (pN2) non-small-cell lung cancer (NSCLC) patients is definitive chemoradiation, surgery can be beneficial for resectable pN2 disease. Herein, we report the long-term clinical outcomes of upfront surgery followed by adjuvant treatment for selected patients with resectable pN2 disease.
We performed a retrospective analysis of clinical outcomes for patients with pN2 disease who underwent surgery as the first-line therapy. Multivariable Cox regression analysis was used to identify the significant factors for overall survival (OS) and recurrence-free survival.
From 2004 to 2015, a total of 706 patients with pN2 NSCLC underwent complete anatomical resection at our institution. The patients' clinical N stages were cN0, 308 (43.6%); cN1, 123 (17.4%) and cN2, 275 (39.0%). Adjuvant chemotherapy, radiotherapy and chemoradiotherapy were administered to 169 (23.9%), 115 (17.4%) and 299 patients (42.4%), respectively. With a median follow-up of 40 months, the respective median time and 5-year rate of OS were 52 months and 44.7%. According to subdivided pN2 descriptors, the median OS time was 80, 53 and 37 months for patients with pN2a1, pN2a2 and pN2b, respectively. Adjuvant chemotherapy was a significant prognostic factor for both OS [hazard ratio (HR) 0.39, 95% confidence interval (CI) 0.28-0.52; P < 0.001] and recurrence-free survival (HR 0.42, 95% CI 0.30-0.58; P < 0.001).
Upfront surgery followed by adjuvant therapy for resectable N2 disease showed favourable outcomes compared to those reported in previous studies. Adjuvant chemotherapy is essential to improve the prognosis for patients undergoing upfront surgery for N2 disease.
尽管病理N2（pN2）期非小细胞肺癌（NSCLC）患者的标准治疗是根治性放化疗，但手术对于可切除的pN2疾病可能有益。在此，我们报告了对部分可切除pN2疾病患者先行手术然后进行辅助治疗的长期临床结果。
我们对接受手术作为一线治疗的pN2疾病患者的临床结果进行了回顾性分析。采用多变量Cox回归分析来确定总生存期（OS）和无复发生存期的显著因素。
2004年至2015年，共有706例pN2期NSCLC患者在我们机构接受了完整的解剖性切除。患者的临床N分期为cN0，308例（43.6%）；cN1，123例（17.4%）；cN2，275例（39.0%）。分别有169例（23.9%）、115例（17.4%）和299例患者（42.4%）接受了辅助化疗、放疗和放化疗。中位随访40个月，OS的中位时间和5年率分别为52个月和44.7%。根据细分的pN2描述符，pN2a1、pN2a2和pN2b患者的OS中位时间分别为80个月、53个月和37个月。辅助化疗是OS[风险比（HR）0.39，95%置信区间（CI）0.28 - 0.52；P < 0.001]和无复发生存期（HR 0.42，95% CI 0.30 - 0.58；P < 0.001）的显著预后因素。
与先前研究报道的结果相比，对可切除的N2疾病先行手术然后进行辅助治疗显示出良好的结果。辅助化疗对于改善接受N2疾病先行手术患者的预后至关重要。
