Department of Thoracic Surgery, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-sen University Cancer Center, Guangzhou, Guangdong, PR China.
VIP Region, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-sen University Cancer Center, Guangzhou, Guangdong, PR China.
Eur J Surg Oncol. 2022 Apr;48(4):752-760. doi: 10.1016/j.ejso.2021.09.023. Epub 2021 Oct 4.
Despite the heterogeneity among patients with stage IB-IIA non-small cell lung cancer (NSCLC), clinically applicable models to identify patients most suitable for receiving adjuvant chemotherapy (ACT) are limited. We aimed to develop a model for risk stratification and the individualized application of ACT.
Between January 2008 and March 2018, patients with T2N0M0 NSCLC at Sun Yat-sen University Cancer Center were retrospectively enrolled. Survival curves were estimated by Kaplan-Meier method and compared with log-rank test. Cox regression models were used to identify prognostic factors for disease-free survival (DFS) and overall survival (OS). Propensity score matching (PSM) was implemented. Subgroup analysis was performed based on clinical risk score (CRS) value and epidermal growth factor receptor (EGFR) mutation status.
Of 1063 patients with T2N0 NSCLC enrolled, 272 patients received ACT. Before PSM, patients with high CRS (>1) had a significantly worse OS and DFS outcomes. In the PSM, the baseline characteristics of the 270 pairs of patients were well matched. ACT was associated with improved OS outcomes for patients with a high CRS, while ACT was associated with improved OS and DFS outcomes in patients with wild-type EGFR. The interaction analysis showed an apparent interaction effect between ACT and EGFR-activating mutations as well as chemotherapy regimens and histology.
The CRS can predict the prognosis of patients with stage IB-IIA NSCLC. ACT could improve the outcome of patients with a high CRS. Patients with non-squamous cell histology receiving pemetrexed plus platinum might benefit more, but not those with EGFR-activating mutations.
尽管 IB-IIA 期非小细胞肺癌（NSCLC）患者存在异质性，但用于识别最适合接受辅助化疗（ACT）的患者的临床适用模型有限。我们旨在开发一种用于风险分层和 ACT 个体化应用的模型。
回顾性纳入中山大学肿瘤防治中心 2008 年 1 月至 2018 年 3 月期间 T2N0M0 NSCLC 患者。采用 Kaplan-Meier 法估计生存曲线，并采用对数秩检验比较。采用 Cox 回归模型确定无病生存（DFS）和总生存（OS）的预后因素。实施倾向评分匹配（PSM）。根据临床风险评分（CRS）值和表皮生长因子受体（EGFR）突变状态进行亚组分析。
纳入 1063 例 T2N0 NSCLC 患者，其中 272 例接受 ACT。在 PSM 之前，CRS 较高（>1）的患者 OS 和 DFS 结果明显较差。在 PSM 中，270 对患者的基线特征匹配良好。ACT 可改善 CRS 较高患者的 OS 结局，而 ACT 可改善野生型 EGFR 患者的 OS 和 DFS 结局。交互分析显示 ACT 与 EGFR 激活突变以及化疗方案和组织学之间存在明显的交互作用。
CRS 可预测 IB-IIA 期 NSCLC 患者的预后。ACT 可以改善 CRS 较高患者的结局。接受培美曲塞联合铂类化疗的非鳞状细胞组织学患者可能受益更多，但并非 EGFR 激活突变患者。
