Instituto do Cancer do Estado de Sao Paulo, Faculdade de Medicina da Universidade de Sao Paulo (SP) Brasil.
Institut Jules Bordet, Université Libre de Bruxelles, Bruxelles, Belgique.
J Bras Pneumol. 2021 Feb 24;47(3):e20200378. doi: 10.36416/1806-3756/e20200378. eCollection 2021.
Adjuvant chemotherapy (AC) improves survival of patients with resected non-small cell lung cancer (NSCLC). However, the cisplatin-vinorelbine regimen has been associated with a significant risk of clinically relevant toxicity. We sought to evaluate the effectiveness, safety, and feasibility of AC for NSCLC patients in a real-world setting.
This was a single-center, retrospective cohort study of patients with stage I-III NSCLC undergoing surgery with curative intent between 2009 and 2018. AC was administered at the discretion of physicians. The patients were divided into two groups: AC group and no AC (control) group. Study outcomes included overall survival (OS) and recurrence-free survival (RFS), as well as the safety profile and feasibility of the cisplatin-vinorelbine regimen in a real-world setting.
The study involved 231 patients, 80 of whom received AC. Of those, 55 patients received the cisplatin-vinorelbine regimen. Survival analyses stratified by tumor stage showed that patients with stage II NSCLC in the AC group had better RFS (p = 0.036) and OS (p = 0.017) than did those in the no AC group. Among patients with stage III NSCLC in the AC group, RFS was better (p < 0.001) and there was a trend toward improved OS (p = 0.060) in comparison with controls. Of those who received the cisplatin-vinorelbine regimen, 29% had grade 3-4 febrile neutropenia, and 9% died of toxicity.
These results support the benefit of AC for NSCLC patients in a real-world setting. However, because the cisplatin-vinorelbine regimen was associated with alarming rates of toxicity, more effective and less toxic alternatives should be investigated.
辅助化疗（AC）可提高可切除非小细胞肺癌（NSCLC）患者的生存率。然而，顺铂-长春瑞滨方案与严重的临床相关毒性风险相关。我们旨在评估在真实环境中 AC 对 NSCLC 患者的有效性、安全性和可行性。
这是一项单中心、回顾性队列研究，纳入了 2009 年至 2018 年间接受根治性手术治疗的 I-III 期 NSCLC 患者。AC 由医生决定是否使用。患者分为 AC 组和无 AC（对照组）组。研究结果包括总生存（OS）和无复发生存（RFS），以及顺铂-长春瑞滨方案在真实环境中的安全性和可行性。
研究共纳入 231 例患者，其中 80 例接受了 AC。其中，55 例患者接受了顺铂-长春瑞滨方案。根据肿瘤分期进行的生存分析显示，AC 组 II 期 NSCLC 患者的 RFS（p=0.036）和 OS（p=0.017）均优于对照组。在 AC 组 III 期 NSCLC 患者中，RFS 更好（p<0.001），且 OS 有改善趋势（p=0.060）。接受顺铂-长春瑞滨方案的患者中，有 29%发生了 3-4 级发热性中性粒细胞减少症，有 9%的患者死于毒性。
这些结果支持在真实环境中对 NSCLC 患者进行 AC 的获益。然而，由于顺铂-长春瑞滨方案与令人担忧的毒性发生率相关，应该探索更有效和毒性更低的替代方案。
