Torrente Maria, Sousa Pedro A, Guerreiro Gracinda R, Franco Fabio, Hernández Roberto, Parejo Consuelo, Sousa Alexandre, Campo-Cañaveral José Luis, Pimentão João, Provencio Mariano
Department of Medical Oncology, Puerta de Hierro-Majadahonda University Hospital, Madrid, Spain.
Faculty of Health Sciences, Francisco de Vitoria University, Madrid, Spain.
Front Oncol. 2023 Feb 23;13:1074337. doi: 10.3389/fonc.2023.1074337. eCollection 2023.
Current prognosis in oncology is reduced to the tumour stage and performance status, leaving out many other factors that may impact the patient´s management. Prognostic stratification of early stage non-small-cell lung cancer (NSCLC) patients with poor prognosis after surgery is of considerable clinical relevance. The objective of this study was to identify clinical factors associated with long-term overall survival in a real-life cohort of patients with stage I-II NSCLC and develop a prognostic model that identifies features associated with poor prognosis and stratifies patients by risk.
This is a cohort study including 505 patients, diagnosed with stage I-II NSCLC, who underwent curative surgical procedures at a tertiary hospital in Madrid, Spain.
Median OS (in months) was 63.7 (95% CI, 58.7-68.7) for the whole cohort, 62.4 in patients submitted to surgery and 65 in patients submitted to surgery and adjuvant treatment. The univariate analysis estimated that a female diagnosed with NSCLC has a 0.967 (95% CI 0.936 - 0.999) probability of survival one year after diagnosis and a 0.784 (95% CI 0.712 - 0.863) five years after diagnosis. For males, these probabilities drop to 0.904 (95% CI 0.875 - 0.934) and 0.613 (95% CI 0.566 - 0.665), respectively. Multivariable analysis shows that sex, age at diagnosis, type of treatment, ECOG-PS, and stage are statistically significant variables (p<0.10). According to the Cox regression model, age over 50, ECOG-PS 1 or 2, and stage ll are risk factors for survival (HR>1) while adjuvant chemotherapy is a good prognostic variable (HR<1). The prognostic model identified a high-risk profile defined by males over 71 years old, former smokers, treated with surgery, ECOG-PS 2.
The results of the present study found that, overall, adjuvant chemotherapy was associated with the best long-term OS in patients with resected NSCLC. Age, stage and ECOG-PS were also significant factors to take into account when making decisions regarding adjuvant therapy.
当前肿瘤学的预后评估仅基于肿瘤分期和体能状态，忽略了许多其他可能影响患者治疗的因素。对术后预后不良的早期非小细胞肺癌（NSCLC）患者进行预后分层具有重要的临床意义。本研究的目的是在一组I-II期NSCLC患者的真实队列中确定与长期总生存相关的临床因素，并开发一种预后模型，以识别与预后不良相关的特征并按风险对患者进行分层。
这是一项队列研究，纳入了505例诊断为I-II期NSCLC并在西班牙马德里一家三级医院接受根治性手术的患者。
整个队列的中位总生存期（以月为单位）为63.7（95%置信区间，58.7-68.7），接受手术的患者为62.4，接受手术及辅助治疗的患者为65。单因素分析估计，诊断为NSCLC的女性在诊断后1年的生存概率为0.967（95%置信区间0.936-0.999），5年后为0.784（95%置信区间0.712-0.863）。对于男性，这些概率分别降至0.904（95%置信区间0.875-0.934）和0.613（95%置信区间0.566-0.665）。多因素分析显示，性别、诊断时年龄、治疗类型、ECOG体能状态评分和分期是具有统计学意义的变量（p<0.10）。根据Cox回归模型，年龄超过50岁、ECOG体能状态评分为1或2以及II期是生存的危险因素（风险比>1），而辅助化疗是一个良好的预后变量（风险比<1）。该预后模型确定了一个高危特征，定义为71岁以上的男性、既往吸烟者、接受手术治疗、ECOG体能状态评分为2。
本研究结果发现，总体而言，辅助化疗与接受手术切除的NSCLC患者的最佳长期总生存期相关。在做出辅助治疗决策时，年龄、分期和ECOG体能状态评分也是需要考虑的重要因素。
