Department of Experimental, Diagnostic and Specialty Medicine, University of Bologna, Bologna, Italy; Medical Oncology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy.
Department of Experimental, Diagnostic and Specialty Medicine, University of Bologna, Bologna, Italy.
Lung Cancer. 2021 Nov;161:18-25. doi: 10.1016/j.lungcan.2021.08.017. Epub 2021 Sep 2.
BACKGROUND: Adjuvant chemotherapy demonstrated a clear benefit in resected non-small cell lung cancer (NSCLC) with nodal disease (stages II-III), and a minimal benefit in tumors >4 cm (stage II, TNM 8th edition). Pleural invasion (PL), classified as visceral pleural invasion (VPI, which includes PL1 and PL2, and parietal pleural invasion (PL3), is an established negative prognostic factor. However, whether PL should influence the decisional algorithm of postoperative chemotherapy is controversial. METHODS: A survival analysis of NSCLC patients who underwent radical surgery between 2010 and 2015 included in the SEER database was performed. Tumor stage and size, number of examined and positive nodes, histology, PL, and treatment data were extracted. Propensity score matching was performed. The benefit of chemotherapy was analyzed in two subgroups: standard of care (SOC), including patients with positive nodes or tumors ≥ 4 cm; non-SOC, including patients with tumors < 4 cm and negative nodes. RESULTS: Records of 30,858 patients were extracted. 11,708 patients were included in the propensity score-matched analysis. In the SOC subgroup, including 8089 patients, all pleural invasion degrees were associated with progressively increased risk for death and shorter overall survival (OS), independently from chemotherapy administration. However, chemotherapy significantly improved the median OS regardless of the extent of PL. In the non-SOC subgroup, including 3619 patients, only PL3 was associated with increased mortality. The administration of chemotherapy did not improve survival outcomes. CONCLUSION: Chemotherapy should be strongly recommended in patients in the SOC-subgroup with pleural invasion. VPI is not associated with unfavorable prognosis in the non-SOC subgroup.
背景:辅助化疗在有淋巴结转移的(II-III 期)可切除非小细胞肺癌(NSCLC)中显示出明显获益,而在肿瘤直径>4cm(II 期,第 8 版 TNM)的患者中获益较小。胸膜侵犯(PL),分为脏层胸膜侵犯(VPI,包括 PL1 和 PL2,和壁层胸膜侵犯(PL3),是一个明确的预后不良因素。然而,PL 是否应该影响术后化疗的决策算法仍存在争议。
方法:对 2010 年至 2015 年期间在 SEER 数据库中接受根治性手术的 NSCLC 患者进行生存分析。提取肿瘤分期和大小、检查和阳性淋巴结数量、组织学、PL 和治疗数据。进行倾向评分匹配。在两个亚组中分析化疗的获益:标准治疗(SOC),包括有阳性淋巴结或肿瘤≥4cm 的患者;非 SOC,包括肿瘤<4cm 且无阳性淋巴结的患者。
结果:提取了 30858 例患者的记录。在倾向评分匹配分析中,包括 11708 例患者。在 SOC 亚组中,包括 8089 例患者,所有 PL 程度均与死亡风险增加和总生存(OS)缩短相关,与化疗的应用无关。然而,无论 PL 程度如何,化疗都显著改善了中位 OS。在非 SOC 亚组中,包括 3619 例患者,仅 PL3 与死亡率增加相关。化疗的应用并不能改善生存结果。
结论:SOC 亚组中伴有胸膜侵犯的患者应强烈推荐化疗。非 SOC 亚组中 VPI 与不良预后无关。
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