Casiraghi Monica, Petrella Francesco, Bardoni Claudia, Mohamed Shehab, Sedda Giulia, Guarize Juliana, Passaro Antonio, De Marinis Filippo, Maisonneuve Patrick, Spaggiari Lorenzo
Department of Thoracic Surgery, IEO, European Institute of Oncology IRCCS, 20141 Milan, Italy.
Department of Oncology and Hemato-Oncology, University of Milan, 20141 Milan, Italy.
J Clin Med. 2023 Mar 6;12(5):2081. doi: 10.3390/jcm12052081.
The suitability of adjuvant therapy (AT) in patients with stage IB non-small cell lung cancer (NSCLC) is still under debate considering the cost-benefit ratio between improvement in survival and side effects. We retrospectively evaluated survival and incidence of recurrence in radically resected stage IB NSCLC, to determine whether AT could significantly improve prognosis. Between 1998 and 2020, 4692 consecutive patients underwent lobectomy and systematic lymphadenectomy for NSCLC. Two hundred nineteen patients were pathological T2aN0M0 (>3 and ≤4 cm) NSCLC 8th TNM. None received preoperative or AT. Overall survival (OS), cancer specific survival (CSS) and the cumulative incidence of relapse were plotted and log-rank or Gray's tests were used to assess the difference in outcome between groups. The most frequent histology was adenocarcinoma (66.7%). Median OS was 146 months. The 5-, 10-, and 15-year OS rates were 79%, 60%, and 47%, whereas the 5-, 10-, and 15-year CSS were 88%, 85%, and 83%, respectively. OS was significantly related to age ( < 0.001) and cardiovascular comorbidities ( = 0.04), whereas number of LNs removed was an independent prognostic factor of CSS ( = 0.02). Cumulative incidence of relapse at 5-, 10-, and 15-year were 23%, 31%, and 32%, respectively, and significantly related to the number of LNs removed ( = 0.01). Patients with more than 20 LNs removed and clinical stage I had a significantly lower relapse ( = 0.02). Excellent CSS, up to 83% at 15-year, and relatively low risk of recurrence for stage IB NSCLC (8th TNM) patients suggested that AT for those patients could be reserved only for very selected high-risk cases.
考虑到辅助治疗（AT）在生存改善与副作用之间的成本效益比，其在ⅠB期非小细胞肺癌（NSCLC）患者中的适用性仍存在争议。我们回顾性评估了接受根治性切除的ⅠB期NSCLC患者的生存率和复发率，以确定AT是否能显著改善预后。1998年至2020年期间，4692例连续患者因NSCLC接受了肺叶切除术和系统性淋巴结清扫术。219例患者为第8版TNM分期的病理T2aN0M0（＞3cm且≤4cm）NSCLC。无一例接受术前或AT治疗。绘制总生存期（OS）、癌症特异性生存期（CSS）和复发累积发生率，并采用对数秩检验或Gray检验评估组间结局差异。最常见的组织学类型为腺癌（66.7%）。中位OS为146个月。5年、10年和15年的OS率分别为79%、60%和47%，而5年、10年和15年的CSS分别为88%、85%和83%。OS与年龄（＜0.001）和心血管合并症（=0.04）显著相关，而清扫的淋巴结数量是CSS的独立预后因素（=0.02）。5年、10年和15年的复发累积发生率分别为23%、31%和32%，且与清扫的淋巴结数量显著相关（=0.01）。清扫淋巴结超过20个且临床分期为Ⅰ期的患者复发率显著较低（=0.02）。ⅠB期NSCLC（第8版TNM）患者具有出色的CSS，15年时高达83%，且复发风险相对较低，这表明仅对极少数选定的高危病例可考虑对这些患者进行AT治疗。
