接受新辅助治疗和手术的临床III期非小细胞肺癌患者：淋巴结特征的预后作用。
Clinical Stage III NSCLC Patients Treated with Neoadjuvant Therapy and Surgery: The Prognostic Role of Nodal Characteristics.
作者信息
Chiappetta Marco, Tabacco Diomira, Iaffaldano Amedeo Giuseppe, Evangelista Jessica, Congedo Maria Teresa, Sassorossi Carolina, Meacci Elisa, D'Argento Ettore, Bria Emilio, Vita Emanuele, Tortora Giampaolo, Boldrini Luca, Charles-Davies Diepriye, Massaccesi Mariangela, Martino Antonella, Mazzarella Ciro, Valentini Vincenzo, Margaritora Stefano, Lococo Filippo
机构信息
Università Cattolica del Sacro Cuore, 00135 Rome, Italy.
Thoracic Surgery, Fondazione Policlinico Universitario A. Gemelli IRCCS, LARGO A. Gemelli 8, 00135 Rome, Italy.
出版信息
Life (Basel). 2022 Nov 1;12(11):1753. doi: 10.3390/life12111753.
BACKGROUND
The aim of this study is to analyze the prognostic factors in patients that underwent induction therapy and surgery for clinical stage III NSCLC. METHODS: Clinical and pathological characteristics of stage III NSCLC patients for N2 involvement that underwent neoadjuvant treatment (NAD) and surgery from 1/01/1998 to 31/12/2017 were collected and retrospectively analyzed. Tumor characteristics, yClinical, yPathological stage and lymph node characteristics were correlated to Overall Survival (OS). RESULTS: The analysis was conducted on 180 patients. Five-year OS (5YOS) was 50.9%. Univariable analysis results revealed old age (p = 0.003), clinical N2 post-NAD (p = 0.01), pneumonectomy (0.005), persistent pathological N2 (p = 0.039, HR 1.9, 95% CI 1.09−2.68) and adjuvant therapy absence (p = 0.049) as significant negative prognostic factors. Multivariable analysis confirmed pN0N1 (p = 0.02, HR 0.29, 95% CI 0.13−0.62) as a favorable independent prognostic factor and adjuvant therapy absence (p = 0.012, HR 2.61, 95% CI 1.23−5.50) as a negative prognostic factor. Patients with persistent N2 presented a 5YOS of 35.3% vs. 55.8% in pN0N1 patients. Regarding lymph node parameters, the lymph node ratio (NR) significantly correlated with OS: 5YOS of 67.6% in patients with NR < 50% vs. 29.5% in NR > 50% (p = 0.029). CONCLUSION: Clinical response aided the stratification of prognosis in patients that underwent multimodal treatment for stage III NSCLC. Adjuvant therapy seemed to be an important option in these patients, while node ratio was a strong prognosticator in patients with persistent nodal involvement.
背景
本研究旨在分析接受诱导治疗和手术的临床 III 期非小细胞肺癌（NSCLC）患者的预后因素。方法：收集 1998 年 1 月 1 日至 2017 年 12 月 31 日期间接受新辅助治疗（NAD）和手术的 III 期 NSCLC 伴 N2 受累患者的临床和病理特征，并进行回顾性分析。将肿瘤特征、y 临床分期、y 病理分期和淋巴结特征与总生存期（OS）进行关联分析。结果：对 180 例患者进行了分析。5 年总生存率（5YOS）为 50.9%。单因素分析结果显示，高龄（p = 0.003）、NAD 后临床 N2（p = 0.01）、肺切除术（0.005）、持续性病理 N2（p = 0.039，HR 1.9，95%CI 1.09−2.68）和未接受辅助治疗（p = 0.049）是显著的负面预后因素。多因素分析证实 pN0N1（p = 0.02，HR 0.29，95%CI 0.13−0.62）是一个有利的独立预后因素，而未接受辅助治疗（p = 0.012，HR 2.61，95%CI 1.23−5.50）是一个负面预后因素。持续性 N2 患者的 5YOS 为 35.3%，而 pN0N1 患者为 55.8%。关于淋巴结参数，淋巴结比率（NR）与 OS 显著相关：NR < 50% 的患者 5YOS 为 67.6%，而 NR > 50% 的患者为 29.5%（p = 0.029）。结论：临床反应有助于对接受 III 期 NSCLC 多模式治疗的患者进行预后分层。辅助治疗似乎是这些患者的重要选择，而淋巴结比率是持续性淋巴结受累患者的一个强有力的预后指标。
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