Pankova Olga V, Rodionov Evgeny O, Miller Sergey V, Tuzikov Sergey A, Tashireva Liubov A, Gerashchenko Tatiana S, Denisov Evgeny V, Perelmuter Vladimir M
Department of General and Molecular Pathology, Cancer Research Institute, Tomsk National Research Medical Center, Tomsk, Russia.
Department of Thoracic Oncology, Cancer Research Institute, Tomsk National Research Medical Center, Tomsk, Russia.
Transl Lung Cancer Res. 2020 Aug;9(4):988-999. doi: 10.21037/tlcr-19-719.
Basal cell hyperplasia (BCH) and squamous metaplasia (SM) in the small bronchi distant from the tumor is associated with a high risk of non-small cell lung cancer (NSCLC) recurrence. Here, we assessed whether neoadjuvant chemotherapy (NAC), intraoperative radiotherapy (IORT), or adjuvant chemotherapy (AC) is effective to prevent recurrence in NSCLC patients (n=171) with different premalignant lesions in the small bronchi.
BCH, SM, and dysplasia (D) were identified in the samples of lung tissue distant from the tumor. NSCLC patients were treated by surgery, different combinations of NAC and IORT, and AC.
Based on the type of bronchial lesions, NSCLC patients were classified into four groups: BCHSMD (55.6%, 95/171), BCHSMD (26.3%; 45/171), BCHSMD (6.4%, 11/171), and BCHSMD (11.7%, 20/171). During 5 years, recurrent carcinoma was found in 13.4% (23/171) of patients and represented by metachronous metastases in the thoracic lymph nodes (82.6%, 19/23) and by a relapse in the bronchial stump (17.4%, 4/23). Recurrence was frequent in BCHSMD patients (87.0%, 20/23), rare in BCHSMD and BCHSMD patients (13.0%, 3/23), and absent in BCHSMD patients (0/23). The 5-year recurrence-free survival was also shorter in BCHSMD patients (HR 27.35; 95% CI: 6.31-118.48; P<0.0001). In the high-risk (BCHSMD) group, recurrence occurred mainly in cases without NAC and IORT (88.2%, 15/17) and was absent (0/15) when these therapies were combined. NAC- and IORT-negative patients also showed poor overall survival (HR 4.35; 95% CI: 1.96-9.66; P<0.0001) and tended to have decreased recurrence-free survival (P=0.075). Importantly, the recurrence rate was not different between AC-treated and AC-naïve BCHSMD patients.
The combination of NAC and IORT is an effective strategy to prevent recurrence in high-risk NSCLC patients.
远离肿瘤的小支气管基底细胞增生（BCH）和鳞状化生（SM）与非小细胞肺癌（NSCLC）的高复发风险相关。在此，我们评估了新辅助化疗（NAC）、术中放疗（IORT）或辅助化疗（AC）是否能有效预防小支气管存在不同癌前病变的NSCLC患者（n = 171）复发。
在远离肿瘤的肺组织样本中识别出BCH、SM和发育异常（D）。NSCLC患者接受手术、NAC与IORT的不同联合治疗以及AC治疗。
根据支气管病变类型，NSCLC患者分为四组：BCHSMD（55.6%，95/171）、BCHSMD（26.3%；45/171）、BCHSMD（6.4%，11/171）和BCHSMD（11.7%，20/171）。在5年期间，13.4%（23/171）的患者出现复发性癌，表现为胸内淋巴结的异时转移（82.6%，19/23）和支气管残端复发（17.4%，4/23）。BCHSMD患者复发频繁（87.0%，20/23），BCHSMD和BCHSMD患者复发罕见（13.0%，3/23），BCHSMD患者未出现复发（0/23）。BCHSMD患者的5年无复发生存期也较短（HR 27.35；95%CI：6.31 - 118.48；P < 0.0001）。在高危（BCHSMD）组中，复发主要发生在未接受NAC和IORT的病例中（88.2%，15/17），而联合使用这些治疗时未出现复发（0/15）。NAC和IORT阴性的患者总体生存率也较差（HR 4.35；95%CI：1.96 - 9.66；P < 0.0001），无复发生存期有缩短趋势（P = 0.075）。重要的是，接受AC治疗和未接受AC治疗的BCHSMD患者的复发率没有差异。
NAC与IORT联合是预防高危NSCLC患者复发的有效策略。
