Lin Xirui, Xu Haijie, Chen Jianrong, Wu Jiaying, Lin Jiong, Wu Hansheng
Shantou University Medical College, Shantou, China.
Department of Thoracic Surgery, The First Affiliated Hospital of Shantou University Medical College, Shantou, China.
Transl Cancer Res. 2024 Nov 30;13(11):6004-6017. doi: 10.21037/tcr-24-33. Epub 2024 Nov 27.
Lung cancer is the most prevailing oncological disease worldwide. Visceral pleural invasion (VPI) has been proven to be a poor prognosis factor for early-stage non-small cell lung carcinoma (NSCLC) patients. However, there remains some debate regarding whether NSCLC patients with tumor size (TS) ranging from >2.0 to 3.0 cm and VPI should be considered for postoperative treatment. This study compared the prognosis of T2a and T2b NSCLC patients, specifically focusing on those with VPI and TS ranging from >2.0-3.0 cm to emphasize the severity of the disease. Additionally, the impact of adjuvant therapies on the outcome of these patients was discussed.
This retrospective research utilized data from the Surveillance, Epidemiology, and End Results (SEER) database, which provided a comprehensive dataset of 10,452 patients diagnosed with pN0M0 NSCLC with TS intervals of >2.0-5.0 cm between 2010 and 2019. The SEER database, renowned for its expansive and population-based cancer data, provides a robust platform for researchers to access a large cohort of patients diagnosed with NSCLC. Survival probabilities were calculated by the Kaplan-Meier method and compared between groups with Log-rank test. Univariate and multivariate logistic analyses were used to identify independent risk factors of VPI.
Patients with NSCLC and TS between >2.0 and 3.0 cm, along with VPI, had a worse 5-year overall survival rate compared to those at T2a stage (49.1% 56.8%, P=0.03) and T2b stage (45.4% 64.2%, P<0.0001). However, no statistical significance was observed when comparing patients with TS range between >2.0 and 3.0 cm and presenting with VPI to those staged T2b and received adjuvant chemotherapy (48.4% 48.5%, P=0.54). Patients with clinical stage of T1c and VPI positive had significantly better prognosis after receiving chemotherapy (34.5% 55.2%, P<0.001). Logistic analysis indicated that age older than 65 years old, poor differentiated and undifferentiated, as well as sub-lobectomy resection were independent risk factors for VPI in NSCLC.
Postoperative chemotherapy can improve the prognosis of patients with TS ranging from >2.0 to 3.0 cm with VPI. According to the analysis of OS based on the postoperative chemotherapy, patients with NSCLC featuring TS extend from >2.0 to 3.0 cm and VPI may be classified within stage IIA. Consequently, the consideration of postoperative chemotherapy for this patient cohort may be warranted.
肺癌是全球最常见的肿瘤性疾病。脏层胸膜侵犯(VPI)已被证明是早期非小细胞肺癌(NSCLC)患者预后不良的因素。然而,对于肿瘤大小(TS)在>2.0至3.0 cm且伴有VPI的NSCLC患者是否应接受术后治疗仍存在一些争议。本研究比较了T2a和T2b期NSCLC患者的预后,特别关注伴有VPI且TS在>2.0 - 3.0 cm的患者,以强调疾病的严重程度。此外,还讨论了辅助治疗对这些患者预后的影响。
这项回顾性研究利用了监测、流行病学和最终结果(SEER)数据库的数据,该数据库提供了2010年至2019年间10452例诊断为pN0M0 NSCLC且TS区间在>2.0 - 5.0 cm的患者的综合数据集。SEER数据库以其广泛的基于人群的癌症数据而闻名,为研究人员提供了一个强大的平台,可用于获取大量诊断为NSCLC的患者队列。通过Kaplan-Meier方法计算生存概率,并使用对数秩检验进行组间比较。单因素和多因素逻辑分析用于确定VPI的独立危险因素。
NSCLC且TS在>2.0至3.0 cm并伴有VPI的患者,其5年总生存率低于T2a期患者(49.1%对56.8%,P = 0.03)和T2b期患者(45.4%对64.2%,P < 0.0001)。然而,将TS在>2.0至3.0 cm并伴有VPI的患者与T2b期且接受辅助化疗的患者进行比较时,未观察到统计学意义(48.4%对48.5%,P = 0.54)。临床分期为T1c且VPI阳性的患者在接受化疗后预后明显更好(34.5%对55.2%,P < 0.001)。逻辑分析表明,年龄大于65岁、低分化和未分化以及肺叶下切除是NSCLC中VPI的独立危险因素。
术后化疗可改善TS在>2.0至3.0 cm并伴有VPI的患者的预后。根据术后化疗的总生存期分析,TS在>2.0至3.0 cm且伴有VPI的NSCLC患者可能可归类为IIA期。因此,对于该患者队列考虑术后化疗可能是合理的。