Santa Marcelina Medicine School, Sao Paulo, Brazil.
Oswaldo Cruz German Hospital, Sao Paulo, Brazil.
J Surg Oncol. 2023 Dec;128(7):1195-1204. doi: 10.1002/jso.27394. Epub 2023 Jul 13.
In stage IIIA non-small cell lung cancer (NSCLC), surgery plays a role in terms of multimodal treatment. Surgery rates have increased in recent years, mainly due to the combination of more accurate imaging tools, electromagnetic navigation bronchoscopy, robotic bronchoscopy, robotic surgery, and a wide range of challenging clinical scenarios to lead surgeons and oncologists to include surgery as an option in therapeutic management.
To assess the prognostic factors, the 5-year overall survival (OS) and cancer-specific survival (CSS) of patients with resectable stage III-NSCLC.
Patients' information was extracted from 76 Hospitals' Cancer Registry. OS and CSS were constructed using the Kaplan-Meier method, and the log-rank test was used to assess differences between curves. In addition, Cox regression was conducted to evaluate the patients' characteristics leading to better OS and CSS.
Overall, 433 stage III NSCLC surgical patients followed over 19 years were included. The median age was 61.29 ± 9.62 years, 58.4% male, 50.1% with adenocarcinoma, 29.3% with squamous cell carcinoma, 3.7% with large-cell lung carcinoma, and 16,9% with other lung cancer types. The 5-year OS was 30.6% (95% confidence interval [CI]: 27.4-36.1), and the CSS was 35.0% (95% CI: 29.4-41.0). In the Cox multivariate regression, squamous cell carcinoma was associated with reduced OS (hazard ratio [HR]: 1.40; 95% CI: 1.07-1.83; p=0.014) and CSS (HR: 1.56; 95% CI: 1.17-2.08; p = 0.002), in comparison with adenocarcinoma. The 2015-2019 quinquennial had a 50% reduction in HR (0.49; 95% CI: 0.29-0.81; p = 0.006), and the 2010-2014 group had a 40% reduction (0.59; 95% CI: 0.42-0.83; p = 0.006) in comparison with the 2000-2004 patients' group.
The OS and CSS of patients with resectable stage III NSCLC have improved over the past 19 years in our region. Squamous cell carcinoma was associated with increased mortality risk from any cause or specific cancer.
在 IIIA 期非小细胞肺癌（NSCLC）中，手术在多模式治疗中发挥作用。近年来，由于更精确的影像学工具、电磁导航支气管镜、机器人支气管镜、机器人手术以及广泛的具有挑战性的临床情况的出现，手术率有所增加，这促使外科医生和肿瘤学家将手术作为治疗管理的一种选择。
评估可切除 IIIA-NCLC 患者的预后因素、5 年总生存率（OS）和癌症特异性生存率（CSS）。
从 76 家医院癌症登记处提取患者信息。使用 Kaplan-Meier 方法构建 OS 和 CSS，并使用对数秩检验评估曲线之间的差异。此外，还进行了 Cox 回归分析，以评估导致患者 OS 和 CSS 更好的患者特征。
总体而言，纳入了 76 家医院癌症登记处的 433 例可切除 IIIA-NCLC 手术患者，随访时间超过 19 年。中位年龄为 61.29±9.62 岁，58.4%为男性，50.1%为腺癌，29.3%为鳞状细胞癌，3.7%为大细胞肺癌，16.9%为其他肺癌类型。5 年 OS 为 30.6%（95%置信区间[CI]：27.4-36.1），CSS 为 35.0%（95%CI：29.4-41.0）。在 Cox 多变量回归中，与腺癌相比，鳞状细胞癌与降低的 OS（风险比[HR]：1.40；95%CI：1.07-1.83；p=0.014）和 CSS（HR：1.56；95%CI：1.17-2.08；p=0.002）相关。与 2000-2004 年患者组相比，2015-2019 年五分位组的 HR 降低了 50%（0.49；95%CI：0.29-0.81；p=0.006），2010-2014 年患者组的 HR 降低了 40%（0.59；95%CI：0.42-0.83；p=0.006）。
在过去的 19 年中，我们地区可切除 IIIA 期 NSCLC 患者的 OS 和 CSS 有所提高。鳞状细胞癌与任何原因或特定癌症的死亡风险增加相关。
