局部晚期中央型非小细胞肺癌肺叶切除术中新辅助化疗的回顾性分析
A retrospective analysis of neoadjuvant chemotherapy in pneumonectomy for locally advanced central non-small cell lung cancer.
作者信息
Wang Yuchen, Dang Zhihang, Jiang Pu, Li Zhifeng, Yang Jin, Gao Kun, Chen Xiaona, Yao Jifang
机构信息
Department of Thoracic Surgery, The Fourth Hospital of Hebei Medical University, Shijiazhuang, China.
出版信息
PeerJ. 2025 Aug 27;13:e20007. doi: 10.7717/peerj.20007. eCollection 2025.
AIMS
The treatment of patients with locally advanced central non-small cell lung cancer (NSCLC) remains controversial. This study aimed to evaluate the effects of neoadjuvant chemotherapy in patients undergoing pneumonectomy.
METHODS
A retrospective analysis was conducted on patients who underwent pneumonectomy with or without neoadjuvant chemotherapy for locally advanced central NSCLC between 2014 and 2019. Categorical variables were compared using the Chi-square or Fisher's exact test. Survival analysis was performed using the Kaplan-Meier method, with comparisons made the log-rank test. Multivariate analysis of independent prognostic factors was conducted using the Cox proportional hazards regression model. A -value < 0.05 was considered statistically significant.
RESULTS
Based on inclusion and exclusion criteria, 104 patients were selected from a total of 6,930, including 69 who received neoadjuvant chemotherapy and 35 who did not. Univariate analysis showed that the neoadjuvant chemotherapy group had significantly improved 5-year overall survival (OS: 29.1% . 12.8%, = 4.089, = 0.043) and disease-free survival (DFS: 22.3% . 8.8%, = 3.941, = 0.047). The downstaging rate in the neoadjuvant chemotherapy group was 29.0%. Subgroup analysis revealed that patients with downstaging had significantly better 5-year OS and DFS compared to those without downstaging (OS: 56.6% . 17.1%, = 10.266, = 0.001; DFS: 54.1% . 6.0%, = 20.785, < 0.001). Another subgroup analysis showed that although 5-year DFS was 0% in both groups, patients with stage cN2 disease who received neoadjuvant chemotherapy had better 5-year OS (16.3% . 7.8%, = 5.603, = 0.018) and a statistically significant difference in DFS ( = 7.328, = 0.007).
CONCLUSIONS
Neoadjuvant chemotherapy significantly improves prognosis in patients with locally advanced central NSCLC undergoing pneumonectomy. Multivariate analysis confirms its positive impact on survival. Patients who experience downstaging after neoadjuvant chemotherapy show notably better outcomes. For patients with stage cN2 disease, neoadjuvant chemotherapy is associated with improved survival.
目的
局部晚期中央型非小细胞肺癌（NSCLC）患者的治疗仍存在争议。本研究旨在评估新辅助化疗对接受肺切除术患者的疗效。
方法
对2014年至2019年间因局部晚期中央型NSCLC接受或未接受新辅助化疗而进行肺切除术的患者进行回顾性分析。分类变量采用卡方检验或Fisher精确检验进行比较。生存分析采用Kaplan-Meier方法，比较采用对数秩检验。使用Cox比例风险回归模型对独立预后因素进行多变量分析。P值<0.05被认为具有统计学意义。
结果
根据纳入和排除标准，从总共6930例患者中选取了104例，其中69例接受了新辅助化疗，35例未接受。单因素分析显示，新辅助化疗组的5年总生存率（OS：29.1%对12.8%，χ² = 4.089，P = 0.043）和无病生存率（DFS：22.3%对8.8%，χ² = 3.941，P = 0.047）显著提高。新辅助化疗组的降期率为29.0%。亚组分析显示，降期患者的5年OS和DFS明显优于未降期患者（OS：56.6%对17.1%，χ² = 10.266，P = 0.001；DFS：54.1%对6.0%，χ² = 20.785，P < 0.001）。另一亚组分析显示，虽然两组的5年DFS均为0%，但接受新辅助化疗的cN2期疾病患者的5年OS更好（16.3%对7.8%，χ² = 5.603，P = 0.018），且DFS有统计学显著差异（χ² = 7.328，P = 0.007）。
结论
新辅助化疗显著改善了接受肺切除术的局部晚期中央型NSCLC患者的预后。多变量分析证实了其对生存的积极影响。新辅助化疗后出现降期的患者预后明显更好。对于cN2期疾病患者，新辅助化疗与生存率提高相关。
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