Qin Xuan, Xiao Xiangzhi, Xia Hongwei, Yang Ke, Zhang Shengchao
Department of Thoracic Surgery, Zhongshan Hospital Qingpu Branch, Fudan University, Shanghai, China.
Transl Cancer Res. 2024 Jun 30;13(6):3003-3015. doi: 10.21037/tcr-24-2. Epub 2024 Jun 16.
Adjuvant chemotherapy (ACT) is a well-recognized and well-established treatment for surgically resected non-small cell lung cancer (NSCLC), but its suitability for elderly patients remains controversial. Further investigation is warranted to guide ACT decisions in this demographic.
We extracted data from the Surveillance, Epidemiology, and End Results (SEER) database, focusing on patients aged 70 years or older who underwent surgical resection for stage IB, II, or III NSCLC as per the 7th edition of the American Joint Committee on Cancer staging system (AJCC 7th edition). Propensity score matching (PSM), Kaplan-Meier analysis, and Cox regression were employed for statistical analyses.
There were 503 participants received ACT in this study of 2,000 patients aged 70 or older with stage IB-IIIB NSCLC who underwent surgical resection without preoperative chemotherapy. Overall, ACT did not significantly correlate with extended overall survival (OS) (P=0.07) compared to non-ACT. After 2:1 PSM, the matched cohort comprised 317 non-ACT and 206 ACT recipients. Post-PSM, the ACT group exhibited improved OS (P=0.044) compared to the non-ACT group. Cox regression analysis identified gender, primary tumor site, histologic grade, N stage, and ACT as independent predictors of OS (P<0.05). Subgroup analysis indicated amplified ACT benefits in individuals aged 70-79 years, male, with N1 stage, or those without radiotherapy.
ACT may confer benefits to elderly stage IB-IIIB NSCLC patients, particularly those aged 70-79 years, male, and with N1 stage.
辅助化疗（ACT）是一种公认的、成熟的手术切除非小细胞肺癌（NSCLC）的治疗方法，但其对老年患者的适用性仍存在争议。有必要进行进一步研究，以指导这一人群的ACT决策。
我们从监测、流行病学和最终结果（SEER）数据库中提取数据，重点关注根据美国癌症联合委员会第7版分期系统（AJCC第7版）接受IB期、II期或III期NSCLC手术切除的70岁及以上患者。采用倾向评分匹配（PSM）、Kaplan-Meier分析和Cox回归进行统计分析。
在这项对2000例70岁及以上接受手术切除且未进行术前化疗的IB-IIIB期NSCLC患者的研究中，有503例患者接受了ACT。总体而言，与未接受ACT相比，ACT与延长总生存期（OS）无显著相关性（P=0.07）。经过2:1的PSM后，匹配队列包括317例未接受ACT和206例接受ACT的患者。PSM后，与未接受ACT组相比，接受ACT组的OS有所改善（P=0.044）。Cox回归分析确定性别、原发肿瘤部位、组织学分级、N分期和ACT是OS的独立预测因素（P<0.05）。亚组分析表明，ACT对70-79岁、男性、N1期或未接受放疗的患者益处更大。
ACT可能对老年IB-IIIB期NSCLC患者有益，特别是70-79岁、男性和N1期患者。
