Kim Bo-Guen, Choi Juwhan, Lee Sun-Kyung, Choi Sue In, Park Chan Kwon, Sim Jae Kyeom, Lee Hyun, Kim Sang-Heon, Sohn Jang Won, Yoon Ho Joo, Lee Sung Yong, Park Dong Won
Department of Internal Medicine, Hanyang University College of Medicine, Seoul, Republic of Korea.
Division of Pulmonary, Allergy, and Critical Care Medicine, Department of Internal Medicine, Korea University Guro Hospital, Korea University College of Medicine, Seoul, Republic of Korea.
J Thorac Dis. 2024 Feb 29;16(2):875-883. doi: 10.21037/jtd-23-936. Epub 2024 Feb 23.
Adjuvant chemotherapy has reduced the risk of recurrence and death in stage IB non-small cell lung cancer (NSCLC) with high-risk factors; however, the impact of visceral pleural invasion (VPI) on outcomes in stage IB NSCLC treated with adjuvant chemotherapy remains controversial. The aim of this study was to explore the clinical and prognostic significance of adjuvant chemotherapy for stage IB (1-4 cm) NSCLC with VPI.
This retrospective study included 251 patients admitted between January 2008 and May 2018 from four hospitals who underwent complete resection for Tumor-Node-Metastasis (TNM) 8th edition stage IB NSCLC with VPI. The relationship between adjuvant chemotherapy and overall survival (OS) or recurrence-free survival (RFS) was analyzed using the Kaplan-Meier method and Cox proportional hazards model.
Of 251 patients with stage IB NSCLC with VPI, 122 (48.6%) received adjuvant chemotherapy after surgical resection and 129 (51.4%) were placed under observation. Multivariable analysis showed that adjuvant chemotherapy was an independent predictor of RFS [adjusted hazard ratio (aHR), 0.57; 95% confidence interval (CI): 0.33-0.96; P=0.036]. A micropapillary pattern (aHR, 2.46; 95% CI: 1.33-4.55; P=0.004) and lymphovascular invasion (aHR, 2.86; 95% CI: 1.49-5.48; P=0.002) were associated with a higher risk of recurrence. Multivariable analysis also showed that adjuvant chemotherapy was an independent predictor of OS (aHR, 0.22; 95% CI: 0.09-0.58; P=0.002). In a subgroup analysis of patients with a tumor size of 1-3 cm, adjuvant chemotherapy was associated with improved RFS and OS, and this association was maintained even when patients with VPI had additional risk factors.
Our study shows that adjuvant chemotherapy is appropriate for patients with stage IB (1-4 cm) NSCLC with VPI, and even those with smaller tumors (1-3 cm).
辅助化疗降低了具有高危因素的ⅠB期非小细胞肺癌（NSCLC）的复发和死亡风险；然而，脏层胸膜侵犯（VPI）对接受辅助化疗的ⅠB期NSCLC患者预后的影响仍存在争议。本研究的目的是探讨辅助化疗对伴有VPI的ⅠB期（1 - 4 cm）NSCLC的临床和预后意义。
这项回顾性研究纳入了2008年1月至2018年5月期间来自四家医院的251例患者，这些患者因第八版肿瘤-淋巴结-转移（TNM）分期为ⅠB期且伴有VPI的NSCLC接受了根治性手术。采用Kaplan-Meier法和Cox比例风险模型分析辅助化疗与总生存期（OS）或无复发生存期（RFS）之间的关系。
在251例伴有VPI的ⅠB期NSCLC患者中，122例（48.6%）在手术切除后接受了辅助化疗，129例（51.4%）接受观察。多变量分析显示，辅助化疗是RFS的独立预测因素[调整后风险比（aHR），0.57；95%置信区间（CI）：0.33 - 0.96；P = 0.036]。微乳头模式（aHR，2.46；95% CI：1.33 - 4.55；P = 0.004）和脉管侵犯（aHR，2.86；95% CI：1.49 - 5.48；P = 0.002）与更高的复发风险相关。多变量分析还显示，辅助化疗是OS的独立预测因素（aHR，0.22；95% CI：0.
