Cen Yanhong, Yang Chunxu, Ren Jiangbo, Gong Yan, Xie Conghua
Department of Radiation and Medical Oncology, Zhongnan Hospital of Wuhan University, Wuhan, China.
Department of Biological Repositories, Zhongnan Hospital of Wuhan University, Wuhan, China.
Ann Transl Med. 2021 Jan;9(1):24. doi: 10.21037/atm-20-3226.
The role of additional chemotherapy in pulmonary sarcomatoid carcinoma (PSC) is controversial. This study aimed to investigate the function of chemotherapy in PSC patients with surgical resection.
PSC patient information between 2004 to 2016 was extracted from the Surveillance, Epidemiology, and End Results (SEER) database. X-tile software was used to calculate the optimal cut-off value to divide groups. The disease stages were recalculated according to the American Joint Commission on Cancer (AJCC) 8 edition tumor-node-metastasis (TNM) staging system. Propensity score matching (PSM) analysis was conducted to balance the baseline of patients. Kaplan-Meier analysis and Cox proportional hazards analysis were used to evaluate survival outcome.
A total of 865 PSC patients were included in our study. Among them, 611 patients were only operated with surgery, and the 254 others were treated with additional chemotherapy. The median age was 69.0 years (interquartile range, 61.6 to 76.3 years). Kaplan-Meier analysis showed that patients with additional chemotherapy had longer overall survival (OS) and cancer-specific survival (CSS, P<0.05). The median OS and the 1-, 3-, 5-year OS rates were 36.0 months (95% CI: 20.5-51.5 months), 72.7%, 49.6% and 38.5% in the chemotherapy group and 29.0 months (95% CI: 23.6-34.4 months), 63.2%, 44.5% and 37.6% in the non-chemotherapy group, respectively. The OS advantage of chemotherapy was not statistically significant after PSM analysis. Moreover, Cox proportional hazards model showed that chemotherapy was an independent prognosis factor for better OS and CSS. In subgroup of stages II and III, the chemotherapy group had a survival advantage (P<0.05). Patients with young age, female gender, low histology grade, large tumor size and lobectomy surgical resection benefited more from chemotherapy.
Chemotherapy is recommended for stages II and III PSC patients undergoing surgery, especially for those with young age, female gender, low histology grade, large tumor size and lobectomy surgical resection.
辅助化疗在肺肉瘤样癌（PSC）中的作用存在争议。本研究旨在探讨化疗在接受手术切除的PSC患者中的作用。
从监测、流行病学和最终结果（SEER）数据库中提取2004年至2016年期间的PSC患者信息。使用X-tile软件计算最佳截断值以进行分组。根据美国癌症联合委员会（AJCC）第8版肿瘤-淋巴结-转移（TNM）分期系统重新计算疾病分期。进行倾向评分匹配（PSM）分析以平衡患者的基线。采用Kaplan-Meier分析和Cox比例风险分析评估生存结局。
本研究共纳入865例PSC患者。其中，611例患者仅接受手术治疗，另外254例接受辅助化疗。中位年龄为69.0岁（四分位间距，61.6至76.3岁）。Kaplan-Meier分析显示，接受辅助化疗的患者总生存期（OS）和癌症特异性生存期（CSS，P<0.05）更长。化疗组的中位OS以及1年、3年、5年OS率分别为36.0个月（95%CI：20.5 - 51.5个月）、72.7%、49.6%和38.5%，非化疗组分别为29.0个月（95%CI：23.6 - 34.4个月）、63.2%、44.5%和37.6%。PSM分析后化疗的OS优势无统计学意义。此外，Cox比例风险模型显示化疗是OS和CSS更好的独立预后因素。在II期和III期亚组中，化疗组具有生存优势（P<0.05）。年龄较小、女性、组织学分级低、肿瘤体积大以及接受肺叶切除术的患者从化疗中获益更多。
对于接受手术的II期和III期PSC患者，推荐进行化疗，特别是年龄较小、女性、组织学分级低、肿瘤体积大以及接受肺叶切除术的患者。
