Division of Thoracic Surgery, Department of Surgery, Kuala Lumpur General Hospital, Kuala Lumpur, Malaysia.
Division of Thoracic Surgery, Department of Surgery, Koo Foundation Sun Yat-Sen Cancer Center, 125, Lide Road, Beitou District, Taipei, 11259, Taiwan.
World J Surg Oncol. 2022 Nov 26;20(1):370. doi: 10.1186/s12957-022-02833-6.
The role of lung surgery in initially unresectable non-small cell lung cancer (NSCLC) after tyrosine kinase inhibitor (TKI) treatment remains unclear. We aimed to assess the survival benefits of patients who underwent surgery for regressed or regrown tumors after receiving TKI treatment.
The details of patients diagnosed with unresectable NSCLC treated with TKI followed by lung resection from 2010 to 2020 were retrieved from our database. The primary endpoint was 3-year overall survival (OS), whereas the secondary endpoints were a 2-year progression-free survival (PFS), feasibility, and the safety of pulmonary resection. The statistical tests used were Fisher's exact test, Kruskal Wallis test, Kaplan-Meier method, Cox proportional hazards model, and Firth correction.
Nineteen out of thirty-two patients were selected for the study. The patients underwent lung surgery after confirmed tumor regression (17 [89.5%]) and regrowth (two [10.5%]). All surgeries were performed via video-assisted thoracoscopic surgery: 14 (73.7%) lobectomies and five (26.3%) sublobar resections after a median duration of 5 months of TKI. Two (10.5%) postoperative complications and no 30-day postoperative mortality were observed. The median postoperative follow-up was 22 months. The 2-year PFS and 3-year OS rates were 43.9% and 61.5%, respectively. Patients who underwent surgery for regressed disease showed a significantly better OS than for regrowth disease (HR=0.086, 95% CI 0.008-0.957, p=0.046). TKI-adjuvant demonstrated a better PFS than non-TKI adjuvant (HR=0.146, 95% CI 0.027-0.782, p=0.025).
Lung surgery after TKI treatment is feasible and safe and prolongs survival via local control and directed consequential therapy. Lung surgery should be adopted in multimodality therapy for initially unresectable NSCLC.
酪氨酸激酶抑制剂（TKI）治疗后，非小细胞肺癌（NSCLC）初始不可切除患者进行肺切除术的作用仍不清楚。我们旨在评估接受 TKI 治疗后肿瘤退缩或复发患者接受手术的生存获益。
从我们的数据库中检索了 2010 年至 2020 年期间接受 TKI 治疗后接受肺切除术的不可切除 NSCLC 患者的详细信息。主要终点为 3 年总生存率（OS），次要终点为 2 年无进展生存率（PFS）、可行性和肺切除的安全性。使用的统计检验是 Fisher 确切检验、Kruskal Wallis 检验、Kaplan-Meier 方法、Cox 比例风险模型和 Firth 校正。
32 例患者中有 19 例入选研究。患者在确认肿瘤消退（17 例，89.5%）和复发（2 例，10.5%）后进行肺手术。所有手术均通过电视辅助胸腔镜手术进行：TKI 治疗 5 个月后，14 例（73.7%）行肺叶切除术，5 例（26.3%）行亚肺叶切除术。观察到 2 例（10.5%）术后并发症和无 30 天术后死亡。中位术后随访时间为 22 个月。2 年 PFS 和 3 年 OS 率分别为 43.9%和 61.5%。手术治疗疾病退缩的患者 OS 明显优于疾病进展的患者（HR=0.086，95%CI 0.008-0.957，p=0.046）。TKI 辅助治疗比非 TKI 辅助治疗的 PFS 更好（HR=0.146，95%CI 0.027-0.782，p=0.025）。
TKI 治疗后进行肺切除术是可行和安全的，并通过局部控制和定向后续治疗延长生存。对于初始不可切除的 NSCLC，肺切除术应纳入多模式治疗。
