Kim Seohyun, Lim Jeong Uk, Kang Hye Seon, Shin Ah Young, Yeo Chang Dong, Kim Sung Kyoung, Park Chan Kwon, Kim Seung Joon, Lee Sang Haak, Kim Jin Woo
Division of Pulmonary, Allergy and Critical Care Medicine, Department of Internal Medicine, Yeouido St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea.
Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Bucheon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea.
Transl Lung Cancer Res. 2023 Jan 31;12(1):79-95. doi: 10.21037/tlcr-22-642. Epub 2023 Jan 13.
BACKGROUND: Surgery is important treatment option for stage III non-small cell lung cancer (NSCLC) because of its curative potential. We investigated the characteristics of resectable patients, and compared the outcomes according to treatment modalities. METHODS: Among 1,092 patients with NSCLC diagnosed between 2008 to 2020 from 7 university hospitals of Catholic Medical Center, we retrospectively analyzed 252 patients with clinical or pathological stage III. We compared survival outcomes among the groups according to resectability, first-line treatments, and the lung immune prognostic index (LIPI) score. Clinical N2 subgroup was analyzed using multi-parameter scoring system. RESULTS: The resectable group consisted of less smokers, showed better pulmonary function and lower inflammatory markers, and tended to be diagnosed as earlier cancer stage than the unresectable group. The resectable group showed better progression-free survival (PFS) and overall survival (OS) than the unresectable group (P<0.001 and P<0.001, respectively). Regarding the first-line treatment, surgery showed the longest median PFS (33.70 months) and the highest 12-month OS rate (91.6%) than the other treatment modalities. OS was significantly different depending on the LIPI score in whole population, as well as in the unresectable group (P=0.004 and P=0.003, respectively). LIPI 0 group exhibited better OS than LIPI 1 and 2 in both populations. Eastern Cooperative Oncology Group (ECOG) 2-4, LIPI 1-2, and first-line treatment were independent prognostic factors for OS. Smoking, forced expiratory volume in the first second (FEV1) and more advanced cancer stage were associated with unresectability. In subgroup analysis of N2 disease, we attempted to create new scoring system combining lymph node (LN) status and LIPI score. This scoring system showed significant association with OS. CONCLUSIONS: The patients with resectable stage III NSCLC showed better PFS and OS than the patients with unresectable tumor. LIPI score exhibited possibility to be used as potential biomarker in stage III NSCLC. The multi-parameter scoring system using LN status and LIPI score was predictive of OS in the N2 subgroup.
背景：由于手术具有治愈潜力，因此手术是Ⅲ期非小细胞肺癌（NSCLC）的重要治疗选择。我们研究了可切除患者的特征，并根据治疗方式比较了治疗结果。 方法：在2008年至2020年间于天主教医疗中心的7家大学医院诊断出的1092例NSCLC患者中，我们回顾性分析了252例临床或病理分期为Ⅲ期的患者。我们根据可切除性、一线治疗和肺免疫预后指数（LIPI）评分比较了各组之间的生存结果。使用多参数评分系统对临床N2亚组进行分析。 结果：可切除组吸烟者较少，肺功能更好，炎症标志物较低，并且与不可切除组相比，倾向于在更早的癌症阶段被诊断出来。可切除组的无进展生存期（PFS）和总生存期（OS）均优于不可切除组（分别为P<0.001和P<0.001）。关于一线治疗，与其他治疗方式相比，手术显示出最长的中位PFS（33.70个月）和最高的12个月OS率（91.6%）。在总体人群以及不可切除组中，OS根据LIPI评分有显著差异（分别为P=0.004和P=0.003）。在这两个人群中，LIPI 0组的OS均优于LIPI 1和2组。东部肿瘤协作组（ECOG）2-4、LIPI 1-2和一线治疗是OS的独立预后因素。吸烟、第一秒用力呼气量（FEV1）和更晚期的癌症阶段与不可切除性相关。在N2疾病的亚组分析中，我们试图创建一种结合淋巴结（LN）状态和LIPI评分的新评分系统。该评分系统与OS有显著相关性。 结论：可切除的Ⅲ期NSCLC患者的PFS和OS优于不可切除肿瘤的患者。LIPI评分显示有可能用作Ⅲ期NSCLC的潜在生物标志物。使用LN状态和LIPI评分的多参数评分系统可预测N2亚组的OS。
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