Xu Yangyang, Wan Bing, Zhu Suhua, Zhang Tianli, Xie Jingyuan, Liu Hongbing, Zhan Ping, Lv Tangfeng, Song Yong
Department of Respiratory and Critical Care Medicine, Jinling Hospital, Nanjing Medical University, Nanjing, China.
Department of Respiratory and Critical Care Medicine, The Affiliated Jiangning Hospital of Nanjing Medical University, Nanjing, China.
Front Oncol. 2022 Jan 27;11:784289. doi: 10.3389/fonc.2021.784289. eCollection 2021.
The efficacy of adjuvant chemotherapy in patients with 8th edition stage IB (tumor size ≤4 cm) non-small cell lung cancer (NSCLC) remains unclear.
We identified 9757 eligible patients (non-chemotherapy group: n=8303; chemotherapy group: n=1454) between 2004 and 2016 from the Surveillance, Epidemiology and End Results (SEER) database. Log-rank test was used to compare overall survival (OS) between the chemotherapy and non-chemotherapy groups. Cox regression model was applied to investigate the independent prognosis factors of all surgically treated stage IB patients, and then the nomogram was constructed. Propensity score matching (PSM) was performed to reduce the confounding bias, and subgroup analyses of the matched cohort were also performed. Finally, we reviewed 184 patients with stage IB NSCLC from July 2008 to December 2016 in Jinling Hospital as a validation cohort, and compared disease-free survival (DFS) and OS between the two groups.
In the SEER database cohort, adjuvant chemotherapy was associated with improved OS in both unmatched and matched (1417 pairs) cohorts (all P <0.05). The survival benefit (both OS and DFS) was confirmed in the validation cohort (P <0.05). Multivariate analysis showed age, race, sex, marital status, histology, tumor location, tumor size, differentiation, surgical method, lymph nodes (LNs) examined, radiotherapy and chemotherapy were prognostic factors for resected stage IB NSCLC (all P <0.05). The concordance index and calibration curves demonstrated good prediction effect. Subgroup analyses showed patients with the following characteristics benefited from chemotherapy: old age, poor differentiation to undifferentiation, 0-15 LNs examined, visceral pleural invasion (VPI), lobectomy and no radiotherapy (all P <0.05).
Adjuvant chemotherapy is associated with improved survival in 8th edition stage IB NSCLC patients, especially in those with old age, poorly differentiated to undifferentiated tumors, 0-15 LNs examined, VPI, lobotomy and no radiotherapy. Further prospective trials are needed to confirm these conclusions. Besides, the nomogram provides relatively accurate prediction for the prognosis of resected stage IB NSCLC patients.
第八版IB期（肿瘤大小≤4 cm）非小细胞肺癌（NSCLC）患者辅助化疗的疗效仍不明确。
我们从监测、流行病学和最终结果（SEER）数据库中确定了2004年至2016年间9757例符合条件的患者（非化疗组：n = 8303；化疗组：n = 1454）。采用对数秩检验比较化疗组和非化疗组的总生存期（OS）。应用Cox回归模型研究所有手术治疗的IB期患者的独立预后因素，然后构建列线图。进行倾向评分匹配（PSM）以减少混杂偏倚，并对匹配队列进行亚组分析。最后，我们回顾了2008年7月至2016年12月在金陵医院的184例IB期NSCLC患者作为验证队列，并比较两组的无病生存期（DFS）和OS。
在SEER数据库队列中，辅助化疗在未匹配和匹配（1417对）队列中均与OS改善相关（所有P <0.05）。在验证队列中证实了生存获益（OS和DFS）（P <0.05）。多因素分析显示年龄、种族、性别、婚姻状况、组织学、肿瘤位置、肿瘤大小、分化程度、手术方式、检查的淋巴结（LNs）、放疗和化疗是切除的IB期NSCLC的预后因素（所有P <0.05）。一致性指数和校准曲线显示出良好的预测效果。亚组分析显示，具有以下特征的患者从化疗中获益：老年、低分化至未分化、检查0 - 15个LNs、脏层胸膜侵犯（VPI）、肺叶切除术且未接受放疗（所有P <0.05）。
辅助化疗与第八版IB期NSCLC患者的生存改善相关，尤其是老年、低分化至未分化肿瘤、检查0 - 15个LNs、VPI、肺叶切除术且未接受放疗的患者。需要进一步的前瞻性试验来证实这些结论。此外，列线图为切除的IB期NSCLC患者的预后提供了相对准确的预测。
