纵隔侵犯型T4期肺癌,新辅助治疗后手术的效果如何?

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  新辅助治疗与局部侵犯T4型肺癌的良好预后相关
  Abstract
  结论
  在NCDB数据库的患者中,相比直接接受手术治疗,接受新辅助治疗后手术的T4N0/1纵隔侵犯肺癌患者,手术切缘的阳性率更低,患者总体生存率更高。
  应当在这些T4患者中考虑使用新辅助治疗。
  In the NCDB, T4N0/1 mediastinal invasion patients who receive neoadjuvant treatment have decreased rates of positive surgical margins and improved overall survival. The use of neoadjuvant treatment should be considered in these patients.
  背景
  新辅助化疗与肺上沟癌生存率的提高有关,但临床上T4型肺癌合并纵隔侵犯患者的资料很少。
  我们假设新辅助治疗与合并纵隔侵犯的T4肺癌患者的生存率提高有关。
  Neoadjuvant chemoradiation is associated with improved survival of superior sulcus cancers, but little data exists regarding clinical T4 lung cancers with mediastinal invasion. We hypothesized neoadjuvant treatment would be associated with improved survival in T4 lung cancer patients with mediastinal invasion.
  方法
  收集2006-2015年国家癌症数据库(NCDB)中临床诊断的T4-N0/1-M0非小细胞肺癌。
  患者接受的手术治疗包括肺叶切除术、双肺叶切除术或全肺切除术。
  新辅助治疗定义为术前化疗和/或放疗。放射治疗后120天以上接受手术的患者被排除在外。
  研究终点为病理切缘状态和总生存率。为了调整异质性,进行了1:1的倾向匹配分析。
  Clinical T4-N0/1-M0 non-small cell lung cancers were identified in the National Cancer Database (NCDB) from 2006-2015. Patients with T4 extension to mediastinal structures undergoing lobectomy, bilobectomy or pneumonectomy were included. Neoadjuvant treatment was defined as preoperative chemotherapy and/or radiation. Patients receiving surgery >120 days after radiation were excluded. Study endpoints were pathologic margin status and overall survival. To adjust for heterogeneity, a 1:1 propensity match analysis was performed.
  结果
  分析了1101例cT4N0/1M0肿瘤患者的临床资料。
  初治手术治疗595例(54.0%),新辅助治疗506例(46.0%)。
  新辅助治疗与手术切缘阳性率较低(46/506(9.3%)vs 186/595(33.1%),p<0.001)相关。
  多因素分析显示新辅助治疗与较低的阳性切缘率(OR 0.220,p<0.001)相关。
  接受新辅助治疗的患者总生存期更长(65.9个月vs 27.5个月,p<0.001)。
  倾向匹配识别出331对匹配的患者。
  其中新辅助治疗后切缘阳性率较低(10.5%vs31.3%,p<0.001)。
  接受新辅助治疗的配对组的总生存率提高(57.0个月vs 27.5个月,p<0.001)。
  1,101 patients with cT4N0/1M0 cancers were analyzed. 595(54.0%) received primary surgery and 506(46.0%) received neoadjuvant treatment. Neoadjuvant therapy was associated with fewer positive surgical margins (46/506(9.3%) vs 186/595(33.1%), p<0.001). Multivariate analysis showed an association of neoadjuvant therapy with a lower rate of positive margin (OR 0.220, p<0.001). Overall survival was longer among patients receiving neoadjuvant treatment (65.9 vs 27.5 months, p<0.001). Propensity matching identified 331 matched pairs of patients. Among them, positive margins were less likely after receiving neoadjuvant treatment (10.5% vs 31.3%, p<0.001). Overall survival among the matched pairs was improved in those receiving neoadjuvant treatment (57.0 vs 27.5 months, p<0.001).
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