Department of Thoracic Surgery, University Hospital Zurich, Zurich, Switzerland.
Swiss Group for Clinical Cancer Research Coordinating Center, Bern, Switzerland.
J Thorac Cardiovasc Surg. 2022 Dec;164(6):1587-1602.e5. doi: 10.1016/j.jtcvs.2022.03.034. Epub 2022 Apr 18.
Surgical treatment of locally advanced non-small cell lung cancer including single or multilevel N2 remains a matter of debate. Several trials demonstrate that selected patients benefit from surgery if R0 resection is achieved. We aimed to assess resectability and outcome of patients with locally advanced clinical T3/T4 (American Joint Committee on Cancer 8 edition) tumors after induction treatment followed by surgery in a pooled analysis of 3 prospective multicenter trials.
A total of 197 patients with T3/T4 non-small cell lung cancer of 368 patients with stage III non-small cell lung cancer enrolled in the Swiss Group for Clinical Cancer Research 16/96, 16/00, 16/01 trials were treated with induction chemotherapy or chemoradiation therapy followed by surgery, including extended resections. Univariable and multivariable analyses were applied for analysis of outcome parameters.
Patients' median age was 60 years, and 67% were male. A total of 38 of 197 patients were not resected for technical (81%) or medical (19%) reasons. A total of 159 resections including 36 extended resections were performed with an 80% R0 and 13.2% pathological complete response rate. The 30- and 90-day mortality were 3% and 7%, respectively, without a difference for extended resections. Morbidity was 32% with the majority (70%) of minor grading complications. The 3-, 5-, and 10-year overall survivals for extended resections were 61% (95% confidence interval, 43-75), 44% (95% confidence interval, 27-59), and 29.5% (95% confidence interval, 13-48), respectively. R0 resection was associated with improved overall survival (hazard ratio, 0.41; P < .001), but pretreatment N2 extension (177/197) showed no impact on overall survival.
Surgery after induction treatment for advanced T3/T4 stage including single and multiple pretreatment N2 disease resulted in 80% R0 resection rate and 7% 90-day mortality. Favorable overall survival for extended and not extended resection was demonstrated to be independent of pretreatment N status.
对于局部晚期非小细胞肺癌（包括单或多水平 N2）的手术治疗仍然存在争议。几项试验表明，如果达到 R0 切除，选择的患者将从手术中受益。我们旨在评估 3 项前瞻性多中心试验的汇总分析中接受诱导治疗后接受手术的局部晚期临床 T3/T4（美国癌症联合委员会第 8 版）肿瘤患者的可切除性和结局。
368 例 III 期非小细胞肺癌患者中，有 197 例 T3/T4 非小细胞肺癌患者被纳入瑞士临床癌症研究组 16/96、16/00 和 16/01 试验，接受诱导化疗或放化疗后接受手术治疗，包括扩大切除术。采用单变量和多变量分析方法分析结局参数。
患者中位年龄为 60 岁，67%为男性。由于技术（81%）或医学（19%）原因，共有 38 例患者未进行切除。共进行了 159 例切除术，包括 36 例扩大切除术，R0 切除率为 80%，病理完全缓解率为 13.2%。30 天和 90 天死亡率分别为 3%和 7%，扩大切除术之间无差异。发病率为 32%，大多数（70%）为轻微分级并发症。扩大切除术的 3 年、5 年和 10 年总生存率分别为 61%（95%置信区间，43-75）、44%（95%置信区间，27-59）和 29.5%（95%置信区间，13-48）。R0 切除与总生存率提高相关（风险比，0.41；P<.001），但术前 N2 扩展（177/197）对总生存率无影响。
诱导治疗后对包括单处和多处术前 N2 疾病在内的晚期 T3/T4 期进行手术治疗，可获得 80%的 R0 切除率和 7%的 90 天死亡率。对于扩大和不扩大切除术，有利的总生存率被证明与术前 N 状态无关。
