Department of Thoracic Surgery, Centre of Thoracic Minimally Invasive Surgery, Peking University People's Hospital, Beijing, China.
Thorac Cancer. 2020 Nov;11(11):3213-3222. doi: 10.1111/1759-7714.13649. Epub 2020 Sep 18.
Non-small cell lung cancer (NSCLC) patients with ipsilateral pleural dissemination (M1a) are generally contraindicated for surgery. Recently, several studies have demonstrated that these patients might benefit from primary tumor resection (PTR). However, whether PTR is beneficial for driver oncogene-positive patients treated with targeted therapy, remains unclear. Here, we investigated the effects of PTR on survival in the era of targeted therapy.
In total, 105 NSCLC patients with ipsilateral pleural dissemination were identified. The mode of systemic treatment was assessed in this study. Survival analysis was performed with the Kaplan-Meier method and Cox proportional hazards regression. The overall survival (OS) of patients with or without PTR was compared between propensity score-matched groups (caliper: 0.02).
In the entire cohort, PTR was associated with improved OS in both unmatched (median survival time [MST]: 50.0 vs. 29.6 months, P = 0.019) and matched (MST: 50.0 vs. 34.4 months, P = 0.052) cohorts. Multivariate regression models showed that surgery was an independent favorable prognostic factor for OS. A total of 70 patients underwent genetic testing, and targeted therapies, such as EGFR-TKIs or ALK-TKIs, were used in the driver oncogene-positive patients. Subgroup analysis showed that PTR did not improve OS in the targeted therapy group (MST: 57.1 months vs. 50.4 months, P = 0.840). However, surgery significantly prolonged survival in the nontargeted therapy group (MST: 39.8 vs. 14.2 months, P = 0.002).
The results of this study indicated that PTR could prolong OS in stage IV NSCLC patients with ipsilateral pleural dissemination, especially in patients who are not candidates for targeted therapy.
Non-small cell lung cancer patients with ipsilateral pleural dissemination can benefit from primary tumor resection. Primary tumor resection could prolong overall survival (OS) in non-small cell lung cancer patients with ipsilateral pleural dissemination who are not candidates for targeted therapy.
患有同侧胸膜播散（M1a）的非小细胞肺癌（NSCLC）患者通常被排除在手术之外。最近，几项研究表明，这些患者可能从原发肿瘤切除术（PTR）中获益。然而，对于接受靶向治疗的驱动基因阳性患者，PTR 是否有益尚不清楚。在这里，我们研究了 PTR 对靶向治疗时代患者生存的影响。
共纳入 105 例同侧胸膜播散的 NSCLC 患者。本研究评估了全身治疗模式。采用 Kaplan-Meier 方法和 Cox 比例风险回归进行生存分析。比较了有无 PTR 的患者之间的总体生存率（OS），并在倾向评分匹配组之间进行比较（卡尺：0.02）。
在整个队列中，在未匹配（中位生存时间 [MST]：50.0 与 29.6 个月，P=0.019）和匹配（MST：50.0 与 34.4 个月，P=0.052）队列中，PTR 均与 OS 改善相关。多变量回归模型表明，手术是 OS 的独立有利预后因素。共有 70 例患者接受了基因检测，在驱动基因阳性患者中使用了 EGFR-TKIs 或 ALK-TKIs 等靶向治疗。亚组分析显示，PTR 并未改善靶向治疗组的 OS（MST：57.1 与 50.4 个月，P=0.840）。然而，手术显著延长了非靶向治疗组的生存时间（MST：39.8 与 14.2 个月，P=0.002）。
本研究结果表明，PTR 可延长同侧胸膜播散的 IV 期 NSCLC 患者的 OS，尤其是在不适合靶向治疗的患者中。
同侧胸膜播散的非小细胞肺癌患者可以从原发肿瘤切除术（PTR）中获益。对于不适合靶向治疗的同侧胸膜播散的非小细胞肺癌患者，PTR 可延长总生存期（OS）。
