Department of Pathophysiology, College of Basic Medical Sciences, Dalian Medical University, Dalian, China.
Department of Urologic Surgery, The First Affiliated Hospital, Guangzhou Medical University, Guangzhou, China.
Eur J Cancer. 2021 Feb;144:326-340. doi: 10.1016/j.ejca.2020.12.002. Epub 2020 Dec 31.
The outcomes of thoracic surgery for patients with stage IV non-small-cell lung cancer (NSCLC) are controversial and uncertain.
The National Cancer Institute's Surveillance, Epidemiology, and End Results was queried for patients with stage IV NSCLC, including those treated with surgery-participated therapy modalities. Overall survival (OS) was evaluated using a variety of statistical analyses.
The analysis was carried out for 90,982 patients from 1975 to 2016 who had been diagnosed as stage IV NSCLC. Propensity score-matched (PSM) analyses that were well-balanced with all the important confounding covariates revealed improved OS (median survival time [MST]) with patients receiving surgery versus non-surgery (MST: 15 versus 8 months, P < 0.001); undergoing surgery plus chemotherapy versus chemotherapy (MST: 19 versus 11 months, P < 0.001); and having surgery plus chemoradiation versus chemoradiation (MST: 18 versus 11 months, P < 0.001). Sequential landmark analyses for long-term survivors of ≥1 and ≥3 years all indicated improved OS (P < 0.001) on univariate and multivariate analyses for the patients receiving the three surgery-related treatment patterns listed earlier, relative to the corresponding surgery-absent treatment modalities. For synchronous presentations of varied treatment paradigms, surgical intervention significantly led to increased OS (MST, months) benefits following treatment paradigms: surgery plus chemotherapy (22), surgery plus chemoradiation (18), chemotherapy (10), surgery only (9), chemoradiation (9), surgery plus radiation (6) and radiation alone (2). The subgroup analysis demonstrated that the elevated OS associated with local thoracic surgery in addition to chemotherapy (versus chemotherapy) or chemoradiation (versus chemoradiation) fell in the subcategories of T0-3, N0-2 and 0-1 (metastatic sites) tumours. The comparison of the aforementioned two types of treatment patterns indicated that the optimal patients for the surgery were those with any combination of T1-4, N0-3, Msite0-1 and adeno- or squamous carcinoma.
The patients with T1-4, N0-3, Msite0-1 and adeno- or squamous carcinoma of stage IV NSCLC had a longer OS with local thoracic surgery in combination with chemotherapy or chemoradiation.
胸外科手术治疗 IV 期非小细胞肺癌（NSCLC）患者的结果存在争议且不确定。
国家癌症研究所的监测、流行病学和最终结果数据库被检索用于 IV 期 NSCLC 患者，包括接受手术联合治疗模式的患者。使用各种统计分析方法评估总生存期（OS）。
对 1975 年至 2016 年间被诊断为 IV 期 NSCLC 的 90982 名患者进行了分析。通过倾向评分匹配（PSM）分析，对所有重要的混杂因素进行了很好的平衡，结果显示手术组患者的 OS 得到改善（中位生存时间[MST]：15 个月 vs 8 个月，P<0.001）；手术联合化疗组患者的 OS 优于单纯化疗组（MST：19 个月 vs 11 个月，P<0.001）；手术联合放化疗组患者的 OS 优于单纯放化疗组（MST：18 个月 vs 11 个月，P<0.001）。对≥1 年和≥3 年的长期幸存者进行序贯里程碑分析，所有患者的 OS 均得到改善（P<0.001），在单变量和多变量分析中，与相应的无手术治疗模式相比，接受上述三种手术相关治疗模式的患者 OS 得到改善。对于不同治疗模式的同步表现，手术干预显著提高了 OS（MST，月）获益，治疗模式如下：手术联合化疗（22 个月）、手术联合放化疗（18 个月）、化疗（10 个月）、手术（9 个月）、放化疗（9 个月）、手术联合放疗（6 个月）和单纯放疗（2 个月）。亚组分析表明，与化疗（化疗）或放化疗（放化疗）相比，局部胸部手术联合化疗或放化疗治疗 IV 期 NSCLC 患者的 OS 升高，与 T0-3、N0-2 和 0-1（转移部位）肿瘤的亚分类有关。对上述两种治疗模式的比较表明，T1-4、N0-3、Msite0-1 和腺癌或鳞状细胞癌的任何组合患者是进行手术的最佳选择。
T1-4、N0-3、Msite0-1 和腺癌或鳞状细胞癌的 IV 期 NSCLC 患者，采用局部胸部手术联合化疗或放化疗，其 OS 较长。
