I期肺腺癌中肿瘤通过气腔播散能否从辅助化疗中获益？一项多机构研究。
Could tumor spread through air spaces benefit from adjuvant chemotherapy in stage I lung adenocarcinoma? A multi-institutional study.
作者信息
Chen Donglai, Wang Xiaofan, Zhang Fuquan, Han Ruoshuang, Ding Qifeng, Xu Xuejun, Shu Jian, Ye Fei, Shi Li, Mao Yiming, Chen Yongbing, Chen Chang
机构信息
Department of Thoracic Surgery, Shanghai Pulmonary Hospital, Tongji University, School of Medicine, Shanghai, China.
Department of Thoracic Surgery, The Second Affiliated Hospital of Soochow University, Suzhou, China.
出版信息
Ther Adv Med Oncol. 2020 Dec 14;12:1758835920978147. doi: 10.1177/1758835920978147. eCollection 2020.
BACKGROUND
The benefit of adjuvant chemotherapy (ACT) remains unknown for patients with stage I lung adenocarcinoma (ADC) with spread through air spaces (STAS). This study investigated the effect of adjuvant chemotherapy in stage I ADC/STAS-positive patients.
METHODS
A total of 3346 patients with stage I ADC from five institutions in China were identified from 2009 to 2013, of whom 1082 were diagnosed with STAS (32.3%). By using the Kaplan-Meier method and Cox proportional hazard regression model, we explored the impact of STAS on prognosis, and determined if the use of adjuvant chemotherapy was associated with improved outcomes in patients with stage I ADC/STAS-positive. A validation cohort was also included in this study.
RESULTS
Patients with stage I ADC/STAS-positive in the primary cohort had unfavorable overall survival (OS) and disease-free survival (DFS). A multivariate Cox regression model confirmed the survival disadvantages of STAS in patients with stage I ADC [OS: hazards ratio (HR) = 1.877, 95% confidence interval (CI): 1.579-2.231; < 0.001; DFS: HR = 1.895, 95% CI: 1.614-2.225; < 0.001]. Lobectomy was associated with better OS and DFS than sublobar resection (SR) in both stage IA and IB ADC/STAS-positive. Similar results were observed in the validation cohort. For patients with stage IB ADC/STAS-positive, ACT was revealed as an independent factor for favorable survival (OS: HR = 0.604, 95% CI: 0.397-0.919; = 0.018; DFS: HR = 0.565, 95% CI: 0.372-0.858; = 0.007). However, among patients with stage IA ADC/STAS-positive, ACT was associated with improved outcomes only for those undergoing SR (OS: HR = 0.787, 95% CI: 0.359-0.949; = 0.034; DFS: HR = 0.703, 95% CI: 0.330-0.904; = 0.029).
CONCLUSION
The presence of STAS was correlated with poor prognosis in patients with stage I ADC. Our study suggested that ACT might be considered for patients with stage IB ADC/STAS-positive and those with stage IA ADC/STAS-positive who underwent SR.
背景
对于伴有气腔播散（STAS）的Ⅰ期肺腺癌（ADC）患者，辅助化疗（ACT）的获益尚不清楚。本研究调查了辅助化疗对Ⅰ期ADC/STAS阳性患者的影响。
方法
2009年至2013年期间，从中国五家机构共纳入3346例Ⅰ期ADC患者，其中1082例被诊断为STAS（32.3%）。通过使用Kaplan-Meier方法和Cox比例风险回归模型，我们探讨了STAS对预后的影响，并确定辅助化疗的使用是否与Ⅰ期ADC/STAS阳性患者的预后改善相关。本研究还纳入了一个验证队列。
结果
在初始队列中，Ⅰ期ADC/STAS阳性患者的总生存期（OS）和无病生存期（DFS）较差。多变量Cox回归模型证实了STAS在Ⅰ期ADC患者中的生存劣势[OS：风险比（HR）=1.877，95%置信区间（CI）：1.579 - 2.231；P<0.001；DFS：HR = 1.895，95% CI：1.614 - 2.225；P<0.001]。在ⅠA期和ⅠB期ADC/STAS阳性患者中，肺叶切除术与比肺段以下切除术（SR）更好的OS和DFS相关。在验证队列中观察到类似结果。对于ⅠB期ADC/STAS阳性患者，ACT被揭示为生存良好的独立因素（OS：HR = 0.604，95% CI：0.397 - 0.919；P = 0.018；DFS：HR = 0.565，95% CI：0.372 - 0.858；P = 0.007）。然而，在ⅠA期ADC/STAS阳性患者中，ACT仅与接受SR的患者的预后改善相关（OS：HR = 0.787，95% CI：0.359 - 0.949；P = 0.034；DFS：HR = 0.703，95% CI：0.330 - 0.904；P = 0.029）。
结论
STAS的存在与Ⅰ期ADC患者的预后不良相关。我们的研究表明，对于ⅠB期ADC/STAS阳性患者以及接受SR的ⅠA期ADC/STAS阳性患者，可考虑进行ACT。
Zotero 插件