Department of Medical Oncology, Sir Run Run Shaw Hospital, College of Medicine, Zhejiang University, Hangzhou, China.
Postgraduate Training Base Alliance of Wenzhou Medical University (Zhejiang Cancer Hospital), Hangzhou, China.
Sci Rep. 2024 Feb 27;14(1):4793. doi: 10.1038/s41598-024-55507-6.
In the 8th edition of the American Joint Committee on Cancer (AJCC) staging system for Non-Small Cell Lung Cancer (NSCLC), tumors exhibiting main bronchial infiltration (MBI) near the carina and those presenting with complete lung obstructive pneumonia/atelectasis (P/ATL) have been reclassified from T3 to T2. Our investigation into the Surveillance, Epidemiology, and End Results (SEER) database, spanning from 2007 to 2015 and adjusted via Propensity Score Matching (PSM) for additional variables, disclosed a notably inferior overall survival (OS) for patients afflicted with these conditions. Specifically, individuals with P/ATL experienced a median OS of 12 months compared to 15 months (p < 0.001). In contrast, MBI patients demonstrated a slightly worse prognosis with a median OS of 22 months versus 23 months (p = 0.037), with both conditions significantly correlated with lymph node metastasis (All p < 0.001). Upon evaluating different treatment approaches for these particular T2 NSCLC variants, while adjusting for other factors, surgery emerged as the optimal therapeutic strategy. We counted those who underwent surgery and found that compared to surgery alone, the MBI/(P/ATL) group experienced a much higher proportion of preoperative induction therapy or postoperative adjuvant therapy than the non-MBI/(P/ATL) group (41.3%/54.7% vs. 36.6%). However, for MBI patients, initial surgery followed by adjuvant treatment or induction therapy succeeded in significantly enhancing prognosis, a benefit that was not replicated for P/ATL patients. Leveraging the XGBoost model for a 5-year survival forecast and treatment determination for P/ATL and MBI patients yielded Area Under the Curve (AUC) scores of 0.853 for P/ATL and 0.814 for MBI, affirming the model's efficacy in prognostication and treatment allocation for these distinct T2 NSCLC categories.
在第八版美国癌症联合委员会（AJCC）非小细胞肺癌（NSCLC）分期系统中，靠近隆突的主支气管浸润（MBI）肿瘤和完全阻塞性肺炎/肺不张（P/ATL）的肿瘤已从 T3 重新分类为 T2。我们对 2007 年至 2015 年期间的监测、流行病学和最终结果（SEER）数据库进行了调查，并通过倾向评分匹配（PSM）对其他变量进行了调整，发现这些情况下患者的总体生存率（OS）明显较低。具体来说，患有 P/ATL 的患者的中位 OS 为 12 个月，而 15 个月（p<0.001）。相比之下，MBI 患者的预后略差，中位 OS 为 22 个月，而 23 个月（p=0.037），两种情况均与淋巴结转移显著相关（均 p<0.001）。在评估这些特定的 T2 NSCLC 变体的不同治疗方法时，我们调整了其他因素，发现手术是最佳治疗策略。我们统计了接受手术的患者，发现与单独手术相比，MBI/（P/ATL）组接受术前诱导治疗或术后辅助治疗的比例明显高于非 MBI/（P/ATL）组（41.3%/54.7%比 36.6%）。然而，对于 MBI 患者，初始手术加辅助治疗或诱导治疗显著提高了预后，而对于 P/ATL 患者则没有这种效果。对于 P/ATL 和 MBI 患者，使用 XGBoost 模型进行 5 年生存预测和治疗决策，AUC 评分分别为 0.853 和 0.814，这证实了该模型在预测和治疗这些不同 T2 NSCLC 类别方面的有效性。
