Department of Medical Oncology, Sun Yat-sen University Cancer Center, Guangzhou City, Guangdong Province, P. R. China; State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-sen University Cancer Center, Guangzhou City, Guangdong Province, P. R. China.
State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-sen University Cancer Center, Guangzhou City, Guangdong Province, P. R. China; Department of Thoracic Surgery, Sun Yat-sen University Cancer Center, Guangzhou City, Guangdong Province, P. R. China.
ESMO Open. 2022 Jun;7(3):100508. doi: 10.1016/j.esmoop.2022.100508. Epub 2022 Jun 7.
The benefit of adjuvant chemotherapy (ACT) in pathological T2N0M0 non-small-cell lung cancer (NSCLC) patients is not clear.
One thousand and fifty pathological T2N0M0 NSCLC patients were included and divided into two groups: with and without ACT. A propensity score matching analysis was carried out to minimize selection bias. The significance of ACT in high-risk patients was further analyzed. The Kaplan-Meier method and Cox proportional hazards model were used to assess the impact of ACT on the overall survival (OS), disease-free survival (DFS), and cancer-specific survival.
For the entire cohort, 31.9% (335/1050) of patients received ACT. After propensity score matching, 325 pairs of patients were matched. OS and DFS were comparable between groups in the original or matched cohort, which was confirmed by the multivariate analysis (all P > 0.05). In high-risk patients, the data suggest that ACT could improve OS and DFS only in patients with tumours >4 cm (OS: P = 0.003; DFS: P = 0.013). ACT could significantly improve the 5-year OS in patients with wild-type epidermal growth factor receptor (EGFR) (P = 0.022). ACT, however, could not improve cancer-specific survival in any subgroup, including patients with tumours >4 cm or wild-type EGFR (all P > 0.05). For patients with other high-risk factors, ACT failed to benefit patients in long-term outcomes.
In resected pT2N0M0 NSCLC patients, those with tumours >4 cm and wild-type EGFR are real high-risk patients and could gain survival benefit from ACT. Further prospective study is needed to confirm the definition.
辅助化疗（ACT）在病理 T2N0M0 期非小细胞肺癌（NSCLC）患者中的获益尚不明确。
共纳入 1050 例病理 T2N0M0 NSCLC 患者，分为接受 ACT 和未接受 ACT 两组。采用倾向性评分匹配分析以尽量减少选择偏倚。进一步分析 ACT 在高危患者中的意义。采用 Kaplan-Meier 法和 Cox 比例风险模型评估 ACT 对总生存（OS）、无病生存（DFS）和癌症特异性生存（CSS）的影响。
全队列中，31.9%（335/1050）的患者接受了 ACT。经倾向性评分匹配后，共匹配了 325 对患者。原始队列和匹配队列中，两组间 OS 和 DFS 均无差异，多因素分析也证实了这一点（均 P＞0.05）。在高危患者中，数据提示 ACT 仅能改善肿瘤＞4cm 患者的 OS 和 DFS（OS：P=0.003；DFS：P=0.013）。ACT 可显著提高野生型表皮生长因子受体（EGFR）患者的 5 年 OS（P=0.022）。然而，ACT 不能改善任何亚组的 CSS，包括肿瘤＞4cm 或野生型 EGFR 患者（均 P＞0.05）。对于存在其他高危因素的患者，ACT 并不能使患者长期获益。
在接受根治性手术的 pT2N0M0 NSCLC 患者中，肿瘤＞4cm 和野生型 EGFR 的患者是真正的高危患者，可从 ACT 中获益。需要进一步的前瞻性研究来确认这一定义。
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