Xu Congcong, Zhu Kanghao, Chen Dong, Ruan Yuhang, Jin Zixian, Qiu Hongbin, Chen Baofu, Shen Jianfei
Key Laboratory of Minimally Invasive Techniques & Rapid Rehabilitation of Digestive System Tumor of Zhejiang Province, Department of Cardiothoracic Surgery, Taizhou Hospital of Zhejiang Province Affiliated to Wenzhou Medical University, Linhai, China.
Key Laboratory of Minimally Invasive Techniques & Rapid Rehabilitation of Digestive System Tumor of Zhejiang Province, Department of Cardiothoracic Surgery, Taizhou Hospital, Zhejiang University, Linhai, China.
Front Surg. 2021 Dec 21;8:795921. doi: 10.3389/fsurg.2021.795921. eCollection 2021.
The benefit of postoperative chemotherapy remains controversial for patients with either a micropapillary or solid pattern in stage IB non-small cell lung cancer. This study is designed to explore the significance of postoperative chemotherapy in patients with either a micropapillary or solid pattern in stage IB lung adenocarcinoma. To conduct the meta-analysis, PubMed, Cochrane Library, Embase and Medline were used to collect literature on long-term follow-up studies published before March, 2021, involving postoperative chemotherapy for patients with both a micropapillary or solid pattern in stage IB lung adenocarcinoma as compared to non-postoperative chemotherapy. Survival data was extracted from the literature, including the overall survival and disease-free survival. Based on overall survival and disease-free survival, hazard ratios and their 95% of confidence intervals were applied to assess the prognostic effect of postoperative chemotherapy. Review Manager software was used to merge the effect size for the meta-analysis. In total, 6 papers with 956 patients were included. In terms of the prognosis of patients suffering from lung cancer when receiving postoperative chemotherapy, this study comprehensively reviews and evaluates the available evidence of micropapillary or solid patterns. After excluding the heterogeneity between the studies, we found that the pooled results from 6 studies report that postoperative chemotherapy was associated with a better overall survival rate when compared with non-postoperative chemotherapy (hazard ratio = 0.58, 95% confidence interval, 0.44-0.77; = 0.0002). Postoperative chemotherapy also significantly improved the disease-free survival in patients with either a micropapillary or a solid pattern in stage IB lung adenocarcinoma (postoperative chemotherapy vs. non-postoperative chemotherapy, hazard ratio = 0.51, 95% confidence interval, 0.40-0.64; < 0.001). However, a subgroup analysis showed that compared with non-postoperative chemotherapy, tumor size was unrelated to the prognosis of patients in stage IB undergoing postoperative chemotherapy (hazard ratio = 0.98, 95% confidence interval, 0.94-1.02; = 0.27). Postoperative chemotherapy results in a better long-term survival rate for patients with either a solid or a micropapillary pattern in stage IB lung adenocarcinoma. Multi-center, prospective, clinical trials are needed to validate our findings.
对于ⅠB期非小细胞肺癌中具有微乳头或实性模式的患者，术后化疗的益处仍存在争议。本研究旨在探讨ⅠB期肺腺癌中具有微乳头或实性模式的患者术后化疗的意义。为进行荟萃分析，使用PubMed、Cochrane图书馆、Embase和Medline收集2021年3月之前发表的关于长期随访研究的文献，这些研究涉及ⅠB期肺腺癌中具有微乳头或实性模式的患者术后化疗与未进行术后化疗的对比。从文献中提取生存数据，包括总生存期和无病生存期。基于总生存期和无病生存期，应用风险比及其95%置信区间来评估术后化疗的预后效果。使用Review Manager软件合并荟萃分析的效应量。总共纳入了6篇文献，涉及956例患者。就接受术后化疗的肺癌患者的预后而言，本研究全面回顾和评估了微乳头或实性模式的现有证据。在排除研究之间的异质性后，我们发现6项研究的汇总结果表明，与未进行术后化疗相比，术后化疗与更好的总生存率相关（风险比=0.58，95%置信区间，0.44-0.77；P=0.0002）。术后化疗也显著改善了ⅠB期肺腺癌中具有微乳头或实性模式患者的无病生存期（术后化疗与未进行术后化疗相比，风险比=0.51，95%置信区间，0.40-0.64；P<0.001）。然而，亚组分析表明，与未进行术后化疗相比，肿瘤大小与ⅠB期接受术后化疗患者的预后无关（风险比=0.98，95%置信区间，0.94-1.02；P=0.27）。术后化疗可使ⅠB期肺腺癌中具有实性或微乳头模式的患者获得更好的长期生存率。需要多中心、前瞻性临床试验来验证我们的研究结果。
