Department of Thoracic and Cardiovascular Surgery, The University of Texas MD Anderson Cancer Center, Houston, Texas.
Department of Thoracic and Cardiovascular Surgery, The University of Texas MD Anderson Cancer Center, Houston, Texas; Department of Pathology, The University of Texas MD Anderson Cancer Center, Houston, Texas.
J Thorac Oncol. 2021 Aug;16(8):1289-1297. doi: 10.1016/j.jtho.2021.03.029. Epub 2021 Apr 20.
Major pathologic response (MPR), defined as residual viable tumor of less than or equal to 10%, currently serves as a surrogate end point for survival for patients with resectable NSCLC after neoadjuvant chemotherapy. However, the significance of pathologic response in lymph nodes harboring metastatic tumors in such patients remains uncertain. Therefore, we studied the effect of neoadjuvant chemotherapy on resected positive lymph nodes and determined if the degree of pathologic response in the lymph nodes alone (LN-MPR) or in combination with that of the primary tumor (PT-MPR) was able to predict the outcome.
A total of 75 patients with NSCLC who underwent neoadjuvant chemotherapy and completed surgical resection were included in this study. Tissue specimens were retrospectively evaluated by two pathologists blinded to the patients' treatments and outcomes. Specimens were reviewed for the degree of pathologic response in the primary tumor and in any involved lymph nodes. The prognostic performance of LN-MPR alone or in combination with PT-MPR with respect to overall survival (OS) was evaluated using the Kaplan-Meier method and Cox regression model.
LN-MPR was significantly predictive of long-term OS after neoadjuvant chemotherapy. A combination of PT-MPR with LN-MPR was significantly associated with outcome and allowed stratification of patients into three prognostic groups (p = 0.001).
LN-MPR in isolation is a reliable predictor of OS in patients with NSCLC receiving neoadjuvant chemotherapy. A combination of LN-MPR with PT-MPR seems to correlate well with the outcome and can be used to predict prognosis in this patient population.
主要病理反应（MPR）定义为残留的活肿瘤小于或等于 10%，目前作为新辅助化疗后可切除 NSCLC 患者生存的替代终点。然而，在存在转移性肿瘤的淋巴结中病理反应的意义在这些患者中仍然不确定。因此，我们研究了新辅助化疗对切除阳性淋巴结的影响，并确定单独的淋巴结病理反应（LN-MPR）或与原发性肿瘤的病理反应（PT-MPR）的程度是否能够预测结局。
本研究共纳入 75 例接受新辅助化疗并完成手术切除的 NSCLC 患者。两名病理学家对组织标本进行了回顾性评估，他们对患者的治疗和结局不知情。评估原发性肿瘤和任何受累淋巴结的病理反应程度。使用 Kaplan-Meier 方法和 Cox 回归模型评估 LN-MPR 单独或与 PT-MPR 联合对总生存期（OS）的预后表现。
LN-MPR 是新辅助化疗后长期 OS 的显著预测因素。PT-MPR 与 LN-MPR 的组合与结局显著相关，并允许将患者分为三个预后组（p=0.001）。
LN-MPR 可单独可靠地预测接受新辅助化疗的 NSCLC 患者的 OS。LN-MPR 与 PT-MPR 的组合似乎与结局密切相关，可用于预测该患者人群的预后。
