[ⅠB期肺腺癌患者术后辅助治疗的选择：653例病例分析]
[Selection of postoperative adjuvant therapy for patients with stage IB lung adenocarcinoma: analysis of 653 cases].
作者信息
Shen L, Chen Y, Yun T, Guo J, Liu X, Zhang T, Liang C, Liu Y
机构信息
Department of Thoracic Surgery, Hainan Hospital of Chinese PLA General Hospital, Sanya 572000, China.
Department of Thoracic Surgery, First Medical Center of Chinese PLA General Hospital, Beijing 100853, China.
出版信息
Nan Fang Yi Ke Da Xue Xue Bao. 2024 May 20;44(5):989-997. doi: 10.12122/j.issn.1673-4254.2024.05.22.
OBJECTIVE
To explore the optimal postoperative adjuvant regimens for patients with stage IB lung adenocarcinoma.
METHODS
We respectively analyzed the data of 653 patients undergoing surgery for stage IB lung adenocarcinoma in our hospital from January, 2013 to December, 2021. The 5-year disease-free survival (DFS) and overall survival (OS) rates were compared among the patients receiving postoperative adjuvant therapy with epidermal growth factor-tyrosine kinase inhibitors (EGFR-TKIs group, =111), chemotherapy (CT group, =108) and clinical observation (CO group, =434).
RESULTS
In TKIs, CT, and CO groups, the 5-year DFS rates were 92.8%, 80.7%, and 81.7%, respectively, significantly higher in TKIs group than in CO group ( < 0.01). The 3-year OS rates of the 3 groups were 96.8%, 97.1%, and 91.7%, respectively. Subgroup analysis showed that in TKIs, CT, and CO groups, the 5-year DFS rates of patients with with T3-4 cmN0M0 were 92.6%, 84.0%, and 81.4%, respectively, significantly higher in TKIs group than in CO group ( < 0.05); the 5-year DFS rates of T2ViscPlN0M0 patients were 95.1%, 71.4%, and 83.5%, respectively. Multivariate COX regression analysis showed that age ( < 0.05; =0.631, 95% : 0.401-0.993), solid nodules ( < 0.01; =7.620, 95% : 3.037-19.121), micropapillary or solid component ( < 0.05; = 1.776, 95% : 1.010-3.122), lymphovascular invasion ( < 0.05; =2.981, 95% : 1.198-7.419), and adjuvant therapy ( < 0.01) were independent predictors of DFS. The most common adverse effects included rashes, paronychia, and diarrhea for TKIs and hematological suppression and gastrointestinal reactions for chemotherapy, and TKIs were associated with a higher incidence of grade 3 or above adverse effects (44.4% 9.0%).
CONCLUSION
Adjuvant therapy with TKIs helps improve DFS in patients with stage IB (T3-4cmN0M0) lung adenocarcinoma but not in patients with T2ViscPlN0M0. Adjuvant chemotherapy does not improve DFS or OS in patients with stage IB lung adenocarcinoma.
目的
探讨ⅠB期肺腺癌患者术后的最佳辅助治疗方案。
方法
我们分别分析了2013年1月至2021年12月在我院接受手术治疗的653例ⅠB期肺腺癌患者的数据。比较接受术后辅助治疗的患者的5年无病生存率（DFS）和总生存率（OS），这些患者分别接受表皮生长因子-酪氨酸激酶抑制剂治疗（EGFR-TKIs组，n = 111）、化疗（CT组，n = 108）和临床观察（CO组，n = 434）。
结果
在TKIs组、CT组和CO组中，5年DFS率分别为92.8%、80.7%和81.7%，TKIs组显著高于CO组（P < 0.01）。三组的3年OS率分别为96.8%、97.1%和91.7%。亚组分析显示，在TKIs组、CT组和CO组中，T3-4cmN0M0患者的5年DFS率分别为92.6%、84.0%和81.4%，TKIs组显著高于CO组（P < 0.05）；T2ViscPlN0M0患者的5年DFS率分别为95.1%、71.4%和83.5%。多因素COX回归分析显示，年龄（P < 0.05；HR = 0.631，95%CI：0.401-0.993）、实性结节（P < 0.01；HR = 7.620，95%CI：3.037-19.121）、微乳头或实性成分（P < 0.05；HR = 1.776，95%CI：1.010-3.122）、脉管侵犯（P < 0.05；HR = 2.981，95%CI：1.198-7.419）和辅助治疗（P < 0.01）是DFS的独立预测因素。最常见的不良反应包括TKIs组的皮疹、甲沟炎和腹泻以及化疗组的血液学抑制和胃肠道反应，TKIs组3级及以上不良反应的发生率更高（44.4%对9.0%）。
结论
TKIs辅助治疗有助于提高ⅠB期（T3-4cmN0M0）肺腺癌患者的DFS，但对T2ViscPlN0M0患者无效。辅助化疗不能提高ⅠB期肺腺癌患者的DFS或OS。
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