非肺癌肺转移瘤手术与化疗的治疗结局：一项倾向评分匹配分析
Treatment outcomes of surgery and chemotherapy for pulmonary metastases from non-lung cancers: a propensity score-matched analysis.
作者信息
Gao Kun, Liu Xianben, Xing Wenqun, Sun Haibo, Liu Shilei, Li Peng, Chen Peinan, Zheng Yan
机构信息
Department of Thoracic Surgery, The Affiliated Cancer Hospital of Zhengzhou University/Henan Cancer Hospital, Zhengzhou, China.
出版信息
Transl Cancer Res. 2023 Mar 31;12(3):585-594. doi: 10.21037/tcr-22-2286. Epub 2023 Feb 13.
BACKGROUND
The optimal treatment for pulmonary metastases has not been determined, and the survival benefit of surgical resection in selected patients remains controversial. The purpose of this retrospective study was to explore whether surgery can prolong survival in patients with pulmonary metastases compared with chemotherapy, and to analyze the factors that may affect the long-term survival of patients with pulmonary metastases.
METHODS
We retrospectively analyzed the medical records of patients with pulmonary metastases from June 2012 to June 2019. Propensity score matching (PSM) was used to balance factors that might affect survival between the two groups. The data were analyzed by Kaplan-Meier survival analysis and Cox proportional hazards models to compare the survival of the surgery group and the chemotherapy group.
RESULTS
A total of 202 patients with pulmonary metastases were enrolled in the study, with 43 patients in the surgery group and 43 in the chemotherapy group after screening and PSM. After PSM, patients in the surgery group had better survival than those in the chemotherapy group, with 5-year overall survival (OS) rates of 75.1% and 48.0%, respectively (P=0.017). Univariate analysis of the two groups of patients found that the treatment method, the number of metastases, and the total diameter of metastases were prognostic factors, but multivariate analysis did not find independent prognostic factors. In the surgical group, univariate analysis found that disease-free interval (DFI), the number of metastases, surgical methods, resection scope and surgical route were prognostic factors, and multivariate analysis showed that only DFI was an independent prognostic factor. In the chemotherapy group, DFI and the response of metastases to chemotherapy were found to be prognostic factors in univariate analysis, but no independent prognostic factors were found in multivariate analysis.
CONCLUSIONS
Surgery does not provide a significant survival advantage. For patients undergoing surgery, longer DFI predicts better survival.
背景
肺转移瘤的最佳治疗方案尚未确定，手术切除对部分患者生存获益仍存在争议。本回顾性研究旨在探讨与化疗相比，手术能否延长肺转移瘤患者的生存期，并分析可能影响肺转移瘤患者长期生存的因素。
方法
回顾性分析2012年6月至2019年6月期间肺转移瘤患者的病历资料。采用倾向评分匹配法（PSM）平衡两组间可能影响生存的因素。通过Kaplan-Meier生存分析和Cox比例风险模型分析数据，比较手术组和化疗组的生存情况。
结果
本研究共纳入202例肺转移瘤患者，经筛选和PSM后，手术组和化疗组各43例。PSM后，手术组患者的生存期优于化疗组，5年总生存率（OS）分别为75.1%和48.0%（P=0.017）。两组患者单因素分析发现，治疗方式、转移瘤数量和转移瘤总直径是预后因素，但多因素分析未发现独立预后因素。手术组单因素分析发现，无病间期（DFI）、转移瘤数量、手术方式、切除范围和手术路径是预后因素，多因素分析显示只有DFI是独立预后因素。化疗组单因素分析发现DFI和转移瘤对化疗的反应是预后因素，但多因素分析未发现独立预后因素。
结论
手术并未提供显著的生存优势。对于接受手术的患者，更长的DFI预示着更好的生存。
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