Bertolaccini Luca, Prisciandaro Elena, Guarize Juliana, Girelli Lara, Sedda Giulia, Filippi Niccolò, de Marinis Filippo, Spaggiari Lorenzo
Department of Thoracic Surgery, IEO, European Institute of Oncology IRCCS, Milan, Italy.
Unit of Interventional Pneumology, IEO, European Institute of Oncology IRCCS, Milan, Italy.
Front Oncol. 2022 Jul 28;12:933278. doi: 10.3389/fonc.2022.933278. eCollection 2022.
Multimodality therapy offers the best opportunity to improve pathological N2 non-small cell lung cancer (NSCLC) prognosis. This paper aimed to evaluate the long-term clinical outcomes and the prognostic factors of upfront surgery as first-line therapy in biopsy-proven clinical N2.
Retrospective review of biopsy-proven cN2 NSCLC patients operated between 2007 and 2017. Upfront surgery was considered if the primary tumour was deemed completely resectable, with mediastinal nodal involvement confined to a single station and no preoperative evidence of extranodal tumour invasion.
Two hundred eighty-five patients who underwent radical resections were included. One hundred fifty-nine patients (55.8%) received induction chemotherapy. At follow-up completion, 127 (44.6%) patients had died. For the induction chemotherapy group, the median overall survival (OS) was 49 months [95% confidence interval (CI): 38-70 months], and the 5-year OS was 44.4%. The median and 5-year OS for the up front surgery group was 66 months (95% CI: 40-119 months) and 66.3%, respectively. There were no statistically significant differences between treatment approaches (p = 0.48). One hundred thirty-four patients (47.0%) developed recurrence. The recurrence-free survival (RFS) at 5 years was 17% (95% CI: 11-25%) for induction chemotherapy and 22% (95% CI: 9-32%) for upfront surgery; there were no statistically significant differences between groups (p = 0.93). No significant differences were observed based on the clinical N status (OS, p = 0.36; RFS, p = 0.65).
Upfront surgery as first-line therapy for biopsy-proven cN2 NSCLC showed favourable clinical outcomes, similar to those obtained after induction chemotherapy followed by surgery. Therefore, it should be considered one of the multimodality treatment options in resectable N2 NSCLC.
多模式治疗为改善病理N2期非小细胞肺癌（NSCLC）的预后提供了最佳机会。本文旨在评估经活检证实为临床N2期的患者，将 upfront 手术作为一线治疗的长期临床疗效和预后因素。
回顾性分析2007年至2017年间接受手术治疗的经活检证实为cN2期NSCLC患者。如果原发性肿瘤被认为可完全切除，纵隔淋巴结受累局限于单个区域，且术前无淋巴结外肿瘤侵犯的证据，则考虑 upfront 手术。
纳入285例行根治性切除术的患者。159例（55.8%）患者接受了诱导化疗。随访结束时，127例（44.6%）患者死亡。诱导化疗组的中位总生存期（OS）为49个月[95%置信区间（CI）：38 - 70个月]，5年总生存率为44.4%。 upfront 手术组的中位和5年总生存期分别为66个月（95%CI：40 - 119个月）和66.3%。两种治疗方法之间无统计学显著差异（p = 0.48）。134例（47.0%）患者出现复发。诱导化疗组5年无复发生存期（RFS）为17%（95%CI：11 - 25%），upfront 手术组为22%（95%CI：9 - 32%）；两组之间无统计学显著差异（p = 0.93）。基于临床N状态未观察到显著差异（总生存期，p = 0.36；无复发生存期，p = 0.65）。
对于经活检证实为cN2期NSCLC患者，将 upfront 手术作为一线治疗显示出良好的临床疗效，与诱导化疗后手术的疗效相似。因此，在可切除的N2期NSCLC中，应将其视为多模式治疗选择之一。
