辅助化疗在完全性切除IB期非小细胞肺癌患者中的倾向匹配分析  

Propensity-matched analysis of adjuvant chemotherapy for completely resected stage IB non-small cell lung cancer patients

作　　者：蔡静静 肖寿勇 吴茂芳 莫欣 周永春[1] CAI Jingjing;XIAO Shouyong;WU Maofang;MO Xin;ZHOU Yongchun(Molecular Diagnostic Subcenter, the Third Affiliated Hospital of Kunming Medical University, Yunnan Cancer Hospital, Kunming 650118,China)

机构地区：[1]昆明医科大学第三附属医院,云南省肿瘤医院分子诊断分中心,昆明650118

出　　处：《临床肿瘤学杂志》2020年第7期601-608,共8页Chinese Clinical Oncology

基　　金：国家自然科学基金资助项目(81860513);云南省科技计划资助项目(2017FA037)。

摘　　要：目的采用倾向性评分匹配(PSM)评估辅助化疗在完全性切除的IB期(T2aN0M0)非小细胞肺癌(NSCLC)患者中的作用。方法从监测、流行病学和最终结果(SEER)数据库中收集2010年至2015年接受完全性切除的IB期NSCLC患者7132例。通过PSM平衡各变量,排除选择偏倚,使用卡方检验比较分类变量,Kaplan-Meier法绘制生存曲线并行Log-rank检验,预后因素分析用Cox比例风险模型。结果共纳入7132例IB期NSCLC患者,其中946例(13.3%)接受辅助化疗,6186例(86.7%)未接受辅助化疗(对照组)。与对照组相比,接受辅助化疗的患者年龄较小、肿瘤分化差(G3~G4)、组织类型多为大细胞肺癌、行肺叶切除及已婚(P<0.01)。通过PSM,402对患者在两组中1∶1匹配且所有临床病理特征均衡良好。PSM前,辅助化疗组的5年生存率优于对照组(P=0.001),而两组患者5年肺癌特异性生存率无显著差异(P=0.121)。PSM后,对照组与辅助化疗组5年生存率和5年肺癌特异性生存率的差异无统计学意义(P=0.747,P=0.075)。PSM后,Cox多因素分析显示,年轻、更多的淋巴结清扫数量是更好的总生存时间(OS)和肺癌特异性生存时间(LCSS)的预测指标(P<0.05),较好的分化程度(G1~G2)仅能改善LCSS(P=0.02),除腺癌外的NSCLC亚型与不良OS有关;然而辅助化疗在OS和LCSS中均未显示出明显优势,但肿瘤≥4 cm的肺癌患者能从辅助化疗中获得更高的5年肺癌特异性生存率。结论辅助化疗对完全切除的IB期NSCLC患者的预后无明显改善作用,仍需进一步大样本多中心研究证实。Objective To evaluate the role of adjuvant chemotherapy in completely resected stage IB(T2N0M0)non-small cell lung cancer(NSCLC)patients by using a propensity score matching(PSM)method.Methods From 2010 to 2015,we collected 7132 eligible NSCLC patients who were diagnosed with stage IB from Surveillance,Epidemiology and End Results(SEER)database.PSM analysis was used for the matching of variables and excluding selection bias.Categorical variables were compared using chi-square tests.Survival curves were generated with the use of Kaplan-Meier estimates.The differences between the curves were analyzed through Log-rank test.Univariate and multivariate Cox proportional hazards regression models were utilized to evaluate prognostic factors.Results A total of 7132 patients with stage IB NSCLC were included in this study,946(13.3%)received adjuvant chemotherapy and 6186(86.7%)underwent surgery alone(observation group).Compared with observation group,patients receiving adjuvant chemotherapy were with younger age,poorly differentiated tumors(G3-G4),large cell lung cancer,lobectomy,and were married(P<0.01).After PSM,402 pairs of patients were 1∶1 matched in the two groups and all baseline characteristics were well balanced.Studies have shown that before PSM,the 5-year overall survival rate of adjuvant chemotherapy group was better than that of observation group(P=0.001),while there was no significant difference in 5-year lung cancer specific survival between the two groups(P=0.121).After PSM,compared with observation group,adjuvant chemotherapy did not improve the 5-year overall survival rate and 5-year lung cancer specific survival rate of patients with stage IB NSCLC.After PSM,multivariate analysis showed that younger and more lymph node clearance were better predictors of overall survival(OS)and lung cancer specific survival(LCSS)(P<0.05),and better differentiated tumors(G1-G2)could only improve LCSS(P=0.02).NSCLC subtypes other than adenocarcinoma were associated with poor OS.Adjuvant chemotherapy could not benefit OS

关 键 词：非小细胞肺癌(NSCLC) IB期 辅助化疗 倾向评分匹配(PSM) 预后 

分 类 号：R734.2[医药卫生—肿瘤]