Rodriguez-Quintero J Humberto, Jindani Rajika, Zhu Roger, Loh Isaac, Kamel Mohamed K, Montal Anne, Vimolratana Marc, Chudgar Neel P, Ohri Nitin, Halmos Balazs, Stiles Brendon M
Department of Cardiovascular and Thoracic Surgery, Montefiore Medical Center/Albert Einstein College of Medicine, Bronx, New York.
Department of Cardiothoracic Surgery, University of Rochester Medical Center, Rochester, New York.
JTO Clin Res Rep. 2024 Nov 14;6(1):100766. doi: 10.1016/j.jtocrr.2024.100766. eCollection 2025 Jan.
Chemoradiation followed by durvalumab is considered a standard approach for patients with locally advanced NSCLC. With improvements in perioperative and neoadjuvant approaches, there is renewed interest in offering surgery to carefully selected patients with cT3/4N2 stage IIIB cancer. We sought to assess survival outcomes after surgery as part of a multimodality treatment regimen for these patients.
Patients with cT3/T4N2M0 NSCLC who received surgery (S) as part of a multimodality approach and patients receiving multimodality treatment without surgery (chemoradiation [CRT] or systemic therapy only) were identified in the National Cancer Database (2010-2019). We evaluated factors associated with the receipt of S (logistic regression). After propensity matching, we estimated the overall survival (OS) of patients who received S and compared with those who received CRT (Kaplan-Meier and Cox regression).
A total of 44,756 patients were identified, of whom 3928 (8.8%) underwent S, 29,798 (66.6%) CRT, and 11,030 (24.6%) systemic therapy only. Fewer comorbidities (Charlson-Deyo index 0 or 1, adjusted OR [aOR]: 1.22, 95% confidence interval [CI]: 1.05-1.42), treatment at an academic facility (aOR: 1.70, 95% CI: 1.52-1.89), private insurance (aOR: 2.44, 95% CI: 1.61-3.69), adenocarcinoma histology (aOR: 1.48, 95% CI: 1.22-1.79), and clinical T3 stage (<7 cm, aOR: 1.70, 95% CI: 1.53-1.89) were associated with S. In well-balanced, propensity-matched cohorts, patients selected for S had better OS compared with those who underwent CRT (hazard ratio 0.59, 95% CI: 0.56-0.63, < 0.001) (median OS 49.7 versus 25.0 mo).
In this retrospective cohort analysis, patients with cT3/4N2, stage IIIB NSCLC who underwent surgical resection had better OS compared with those patients treated with CRT. Careful patient selection is undoubtedly critical, but stage IIIB designation alone should not exclude patients from surgical consideration.
对于局部晚期非小细胞肺癌（NSCLC）患者，化疗放疗后使用度伐利尤单抗被认为是一种标准治疗方法。随着围手术期和新辅助治疗方法的改进，对于经过精心挑选的cT3/4N2 IIIB期癌症患者，重新出现了提供手术治疗的兴趣。我们试图评估手术作为这些患者多模式治疗方案一部分后的生存结果。
在国家癌症数据库（2010 - 2019年）中识别接受手术（S）作为多模式治疗一部分的cT3/T4N2M0 NSCLC患者，以及接受无手术的多模式治疗（仅化疗放疗[CRT]或全身治疗）的患者。我们评估了与接受手术相关的因素（逻辑回归）。在倾向匹配后，我们估计接受手术患者的总生存期（OS），并与接受CRT的患者进行比较（Kaplan - Meier法和Cox回归）。
共识别出44756例患者，其中3928例（8.8%）接受了手术，29798例（66.6%）接受了CRT，11030例（24.6%）仅接受了全身治疗。合并症较少（Charlson - Deyo指数为0或1，调整后比值比[aOR]：1.22，95%置信区间[CI]：1.05 - 1.42）、在学术机构接受治疗（aOR：1.70，95% CI：1.52 - 1.89）、拥有私人保险（aOR：2.44，95% CI：1.61 - 3.69）、腺癌组织学类型（aOR：1.48，95% CI：1.22 - 1.79）以及临床T3期（<7 cm，aOR：1.70，95% CI：1.53 - 1.89）与接受手术相关。在平衡良好的倾向匹配队列中，选择接受手术的患者与接受CRT的患者相比，OS更好（风险比0.59，95% CI：0.56 - 0.63，P < 0.001）（中位OS为49.7个月对25.0个月）。
在这项回顾性队列分析中，接受手术切除的cT3/4N2 IIIB期NSCLC患者与接受CRT治疗的患者相比，OS更好。仔细的患者选择无疑至关重要，但仅III B期这一诊断不应排除患者接受手术的考虑。
