不同分期标准下IB期非小细胞肺癌辅助化疗的筛选  

stagingsystem

作　　者：王嘉[1] 吴楠[1] 吕超[1] 杨跃[1] WANG Jia;WU Nan;LV Chao;YANG Yue.(Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Department of Thoracic Surgery II, Peking University Cancer Hospital & Institute, Beijing 100142, China)

机构地区：[1]北京大学肿瘤医院暨北京市肿瘤防治研究所胸外二科恶性肿瘤发病机制及转化研究教育部重点实验室,北京100142

出　　处：《临床肿瘤学杂志》2021年第3期222-227,共6页Chinese Clinical Oncology

基　　金：国家重点研发计划资助项目(2018YFC0910700)。

摘　　要：目的比较国际抗癌联盟(UICC)/美国癌症联合委员会(AJCC)肿瘤,淋巴结和转移(TNM)第7版和第8版分期系统对评估IB期非小细胞肺癌(NSCLC)患者术后辅助化疗作用的差异。方法回顾性分析2008年10月至2018年4月因NSCLC接受手术的患者资料。根据TNM分期第8版和第7版对纳入患者进行分期,比较含铂辅助化疗对IB期NSCLC患者总生存时间(OS)的影响。预后多因素分析采用Cox比例风险回归模型。结果共纳入651例根据第7版TNM分期属于IB期的NSCLC患者;根据第8版进行分期后,651例患者中包括457例术后病理为IB期(T_(2a)N_(0)M_(0))和194例IIA期(T_(2b)N_(0)M_(0))患者。观察组(n=366)和辅助化疗组(n=285)的5年生存率分别为76.9%和83.5%(P=0.026)。Cox多因素分析显示,TNM分期、ECOG评分和辅助化疗是影响OS的独立因素(P<0.05)。亚组分析显示,对于按照第8版分期为IB期的NSCLC患者,观察组和辅助化疗组的5年生存率分别为87.7%和82.0%(P=0.008);而对于按照第8版分期为IIA期的NSCLC患者,辅助化疗组的5年生存率为88.0%,高于观察组的48.7%(P<0.001)。对于ECOG评分为0的患者,辅助化疗组的5年生存率优于观察组(91.8%vs.79.5%,P<0.001);而ECOG评分为1的患者,辅助化疗组的5年生存率低于观察组(16.9%vs.58.6%,P=0.004)。结论相比于第7版UICC/AJCC TNM分期,第8版分期可以更好地选择早期NSCLC辅助化疗的获益人群;此外,按照第8版分期,具有良好ECOG评分的IB及IIA期患者可以受益于辅助化疗。Objective To compare the efficacy of adjuvant chemotherapy in resected patients with stage IB non-small cell lung cancer(NSCLC)according to the 7th and 8th editions of the Union for International Cancer Control(UICC)/American Association of Cancer(AJCC)tumor,node,and metastasis(TNM)staging systems,respectively.Methods This retrospective analysis was done on those who underwent pulmonary resection for primary NSCLC from October 2008 to April 2018.According to the 8th and 7th edition of TNM staging,the effect of platinum-based adjuvant chemotherapy on the overall survival(OS)of patients with stage IB NSCLC was compared.Cox proportional hazard regression model was used for multivariate analysis.Results A total of 651 NSCLC patients with stage IB according to the 7th edition of TNM staging were included.According to the 8th edition of TNM staging,457 patients with stage IB(T_(2a)N_(0)M_(0))and 194 patients with stage IIA(T_(2b)N_(0)M_(0))were included.The 5-year survival rates of observation group(n=366)and adjuvant chemotherapy group(n=285)were 76.9%and 83.5%,respectively(P=0.026).Cox multivariate analysis showed that TNM staging,ECOG score and adjuvant chemotherapy were independent factors affecting OS(P<0.05).Subgroup analysis showed that the 5-year survival rates of observation group and adjuvant chemotherapy group were 87.7%and 82.0%(P=0.008)respectively for the patients with stage IB NSCLC according to the 8th edition of TNM staging system;for the patients with IIA NSCLC according to the 8th edition of TNM staging system,the 5-year survival rate of adjuvant chemotherapy group was 88.0%,higher than 48.7%of observation group(P<0.001).For patients with ECOG score of 0,the 5-year survival rate of adjuvant chemotherapy group was better than that of observation group(91.8%vs.79.5%,P<0.001);while for patients with ECOG score of 1,the 5-year survival rate of adjuvant chemotherapy group was lower than that of observation group(16.9%vs.58.6%,P=0.004).Conclusion Compared with the 7th edition of TNM staging,the 8th edition

关 键 词：非小细胞肺癌 肿瘤、淋巴结和转移分期系统 IB期 辅助化疗 ECOG评分 

分 类 号：R734.2[医药卫生—肿瘤]