Department of Cardiothoracic Surgery, University of Pittsburgh School of Medicine and University of Pittsburgh Medical Center, Pittsburgh, PA.
Department of Cardiothoracic Surgery, University of Pittsburgh School of Medicine and University of Pittsburgh Medical Center, Pittsburgh, PA; Surgical Services Division, Veterans Affairs Pittsburgh Healthcare System, Pittsburgh, PA.
Clin Lung Cancer. 2021 Jan;22(1):e132-e135. doi: 10.1016/j.cllc.2020.09.002. Epub 2020 Sep 18.
The standard of care in the management of stage I non-small-cell lung cancer (NSCLC) has been anatomic lung resection with multistation lymph node sampling of ≥ 10 lymph nodes. The 5-year survival for NSCLC has ranged from 73% to 93% (for stage IB and stage IA, respectively) and will be more favorable for patients with fewer comorbidities and those with a higher state of premorbid functioning and who undergo surgical resection. Despite the positive prognosis for operable stage I NSCLC, a subset of patients will develop metastatic disease within as few as 12 months after resection. Using an institutional database, we have presented the data from 68 patients who had developed distant metastatic recurrence after resection of pathologic stage I NSCLC within 1 year after surgery.
A retrospective study was conducted of a prospectively maintained intuitional database. The final cohort included patients with pathologic stage I NSCLC who had undergone anatomic resection but had subsequently presented with multiple sites of distant recurrence within 1 year. The study period extended from 2003 to 2020. Patients with broad local recurrence or recurrence at a single distant site were excluded. Kaplan-Meier analysis was used to estimate the 5-year survival.
A total of 2827 patients had undergone surgical resection for stage I NSCLC during the 17-year period and 68 met the criteria for inclusion. Most of the patients (n = 48) were smokers, and the dominant histologic type was adenocarcinoma (n = 37). After recurrence, 22 patients (33%) had undergone chemoradiotherapy and 19 (28%) had received chemotherapy alone. The mean and median overall survival were 23.7 and 14 months, respectively. The 5-year survival from recurrence and surgery were both 13.2%.
Limited data are available on the risk factors for early metastasis after resected stage I NSCLC. The results from our cohort have demonstrated poor survival after recurrence. These data might be the basis for determining a phenotype for patients prone to early widespread metastasis despite seemingly curative surgical resection.
I 期非小细胞肺癌（NSCLC）的标准治疗方法是解剖性肺切除术，对 10 个以上淋巴结进行多部位淋巴结取样。NSCLC 的 5 年生存率为 73%至 93%（分别为 IB 期和 IA 期），对于合并症较少、术前功能状态较高且接受手术切除的患者更为有利。尽管 I 期可手术 NSCLC 的预后良好，但仍有一部分患者在手术后 12 个月内发生远处转移疾病。本研究使用机构数据库，报告了 68 例手术后 1 年内病理分期为 I 期 NSCLC 患者发生远处转移复发的资料。
对前瞻性维护的机构数据库进行回顾性研究。最终队列包括接受解剖性肺切除术但术后 1 年内出现多处远处复发的病理 I 期 NSCLC 患者。研究时间从 2003 年延长至 2020 年。排除广泛局部复发或单个远处部位复发的患者。采用 Kaplan-Meier 分析估计 5 年生存率。
在 17 年期间，共有 2827 例患者接受 I 期 NSCLC 手术治疗，68 例符合纳入标准。大多数患者（n=48）为吸烟者，主要组织学类型为腺癌（n=37）。复发后，22 例（33%）患者接受了放化疗，19 例（28%）患者仅接受了化疗。总生存期和中位总生存期分别为 23.7 和 14 个月。复发和手术的 5 年生存率均为 13.2%。
关于切除的 I 期 NSCLC 后早期转移的危险因素，目前数据有限。本队列的结果显示，复发后的生存情况较差。这些数据可能为确定尽管接受了看似治愈性手术切除但仍易发生早期广泛转移的患者表型提供依据。
