术后化疗显著改善 IB-II 期老年非小细胞肺癌患者的生存：一项基于人群的研究。
Postoperative chemotherapy significantly improves survival of elderly patients with stage IB-II non-small cell lung cancer: A population-based study.
机构信息
Department of Respiratory Medicine, Shanghai Tenth People's Hospital, Tongji University School of Medicine, Shanghai, 200072, China.
出版信息
Cancer Med. 2023 May;12(10):11254-11263. doi: 10.1002/cam4.5834. Epub 2023 Apr 9.
BACKGROUND
There is scant evidence-based information about survival benefits of postoperative chemotherapy in elderly patients with early-stage non-small cell lung cancer (NSCLC). The purpose of this study is to compare the overall survival (OS) and cancer-specific survival (CSS) rates of surgery alone versus postoperative chemotherapy in patients aged ≥70 years with stage I-II NSCLC.
METHODS
Elderly patients aged ≥70 years diagnosed with stage I-II NSCLC were selected from the Surveillance, Epidemiology, and End Results (SEER) database from January 1, 2010 to December 31, 2015. OS and CSS were compared between the two groups utilizing overlap weighting analysis, inverse probability of treatment weight (IPTW), and propensity score matching (PSM).
RESULTS
Of the 7193 included patients with stage I-II NSCLC who are more than 70 years old, 681 patients (9.5%) received postoperative chemotherapy and 6512 patients (90.5%) received surgery-alone. Median OS was 77 months in postoperative chemotherapy group versus 79 months in surgery-alone group (p = 0.89). The result of IPTW analysis showed the similar results. The probability of patients choosing chemotherapy increased with the AJCC stage and Grade increasing (p < 0.001) and decreased with the growth of age (p < 0.001). The results of subgroup analysis showed that the survival rate of stage IA patients decreased significantly after postoperative chemotherapy (p < 0.01) while the survival rate of stage IB-II patients increased significantly (p < 0.01). At the same time, we found that patients in the postoperative chemotherapy group tended to have better OS than those in the surgery-alone group with the grade and tumor size increasing.
CONCLUSION
The results of this study indicated that postoperative chemotherapy could significantly improve the survival of stage IB-II NSCLC patients aged ≥70 years, and decrease the survival of stage IA patients.
背景
关于早期非小细胞肺癌（NSCLC）老年患者术后化疗的生存获益，仅有少量基于证据的信息。本研究旨在比较手术与术后化疗在 70 岁及以上 I 期- II 期 NSCLC 患者中的总生存期（OS）和癌症特异性生存期（CSS）。
方法
从 2010 年 1 月 1 日至 2015 年 12 月 31 日，从监测、流行病学和最终结果（SEER）数据库中选择 70 岁及以上诊断为 I 期- II 期 NSCLC 的老年患者。利用重叠加权分析、逆概率处理权重（IPTW）和倾向评分匹配（PSM）比较两组间的 OS 和 CSS。
结果
在纳入的 7193 例 70 岁以上 I 期- II 期 NSCLC 患者中，681 例（9.5%）接受术后化疗，6512 例（90.5%）接受单纯手术。术后化疗组中位 OS 为 77 个月，单纯手术组为 79 个月（p=0.89）。IPTW 分析结果相似。选择化疗的概率随 AJCC 分期和分级的升高而增加（p<0.001），随年龄的增长而降低（p<0.001）。亚组分析结果显示，IA 期患者术后化疗后生存率显著下降（p<0.01），而 IB-II 期患者生存率显著升高（p<0.01）。同时，我们发现随着分级和肿瘤大小的增加，术后化疗组患者的 OS 较单纯手术组有改善的趋势。
结论
本研究结果表明，术后化疗可显著改善 70 岁及以上 I 期- II 期 NSCLC 患者的生存，降低 IA 期患者的生存。
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