Shigenobu Takao, Taniguchi Yuri, Suzuki Takahiro, Tabuchi Yuya, Sato Mizuki, Odagiri Kazumasa, Nakamura Yukiko, Shimokawa Tsuneo, Okamoto Hiroaki, Yoshizu Akira
Department of Thoracic Surgery, Yokohama Municipal Citizen's Hospital, 1-1, Mitsuzawanishimachi, Kanagawa-ku, Yokohama City, Kanagawa Prefecture, 221-0855, Japan.
Department of Respiratory Medicine, Yokohama Municipal Citizen's Hospital, Kanagawa, Japan.
BMC Cancer. 2025 Jan 22;25(1):121. doi: 10.1186/s12885-025-13550-0.
No study has directly compared the outcomes of surgery and concurrent chemoradiotherapy (cCRT) in patients with stage III non-small cell lung cancer (NSCLC) to date. This study aimed to compare the treatment efficacy of complete resection and definitive cCRT.
Patients were recruited in this retrospective study from Yokohama Municipal Citizens' Hospital between January 2013 and December 2022. We analyzed patients with pathological stage III NSCLC who underwent complete surgical resection and those with clinical stage III NSCLC who underwent definitive cCRT. Propensity score matching was performed to balance baseline clinicopathological factors, and the prognoses of patients in each treatment group were examined using Cox proportional hazards regression.
Of the 923 patients with NSCLC who underwent surgery, 97 with pathologic stage III NSCLC underwent complete resection (surgery group) and 125 with clinical stage III NSCLC underwent cCRT (cCRT group), of whom 54 (43.2%) received consolidation therapy with durvalumab. Overall survival (OS) was significantly higher in the surgery group than in the cCRT group (5-year OS: 60.5% versus 43.0%), hazard ratio [HR] = 0.585, 95% confidence interval [CI]: 0.390-0.877, p = 0.010). However, no significant difference in OS was found between the two groups after propensity score matching (5-year OS: 59.8% versus 48.1%, HR = 0.728, 95% CI: 0.416-1.277, p = 0.268).
The outcomes of the surgery and cCRT groups did not significantly differ in the treatment of stage III NSCLC. Appropriate evaluation of the treatment required should be reviewed on a case-by-case basis.
迄今为止，尚无研究直接比较Ⅲ期非小细胞肺癌（NSCLC）患者手术与同步放化疗（cCRT）的疗效。本研究旨在比较完全切除与根治性cCRT的治疗效果。
本回顾性研究纳入了2013年1月至2022年12月间横滨市市民医院的患者。我们分析了接受完全手术切除的病理Ⅲ期NSCLC患者以及接受根治性cCRT的临床Ⅲ期NSCLC患者。进行倾向评分匹配以平衡基线临床病理因素，并使用Cox比例风险回归分析每个治疗组患者的预后。
在923例行手术的NSCLC患者中，97例病理Ⅲ期NSCLC患者接受了完全切除（手术组），125例临床Ⅲ期NSCLC患者接受了cCRT（cCRT组），其中54例（43.2%）接受了度伐利尤单抗巩固治疗。手术组的总生存期（OS）显著高于cCRT组（5年OS：60.5%对43.0%），风险比[HR]=0.585，95%置信区间[CI]：0.390 - 0.877，p = 0.010）。然而，倾向评分匹配后两组的OS无显著差异（5年OS：59.8%对48.1%，HR = 0.728，95% CI：0.416 - 1.277，p = 0.268）。
在Ⅲ期NSCLC的治疗中，手术组和cCRT组的疗效无显著差异。应根据具体情况对所需治疗进行适当评估。
