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中华胸部外科电子杂志 ›› 2025, Vol. 12 ›› Issue (01) : 12 -23. doi: 10.3877/cma.j.issn.2095-8773.2025.01.02

论著

术后辅助化疗对R0 切除T2bN0M0 非小细胞肺癌患者预后的影响
赵丹文1, 刘丹丹2, 李文登1, 孔冉冉1, 刘士源1,()   
  1. 1. 710004 西安,西安交通大学第二附属医院胸外科
    2. 710004 西安,西安交通大学第二附属医院肿瘤科
  • 收稿日期:2024-09-21 修回日期:2024-10-23 接受日期:2025-01-24 出版日期:2025-02-28
  • 通信作者: 刘士源
  • 基金资助:
    国家自然科学基金(82373002)陕西省重点研发计划(2023-YBSF-359)

Impact of adjuvant chemotherapy on survival for patients with completely resected stage T2bN0M0 non-small cell lung cancer

Danwen Zhao1, Dandan Liu2, Wendeng Li1, Ranran Kong1, Shiyuan Liu1,()   

  1. 1. Department of Thoracic Surgery,The Second Affiliated Hospital of Xi'an Jiaotong Uniνersity,Xi'an 710004,China
    2. Department of Oncology,The Second Affiliated Hospital of Xi'an Jiaotong Uniνersity,Xi'an 710004,China
  • Received:2024-09-21 Revised:2024-10-23 Accepted:2025-01-24 Published:2025-02-28
  • Corresponding author: Shiyuan Liu
引用本文:

赵丹文, 刘丹丹, 李文登, 孔冉冉, 刘士源. 术后辅助化疗对R0 切除T2bN0M0 非小细胞肺癌患者预后的影响[J/OL]. 中华胸部外科电子杂志, 2025, 12(01): 12-23.

Danwen Zhao, Dandan Liu, Wendeng Li, Ranran Kong, Shiyuan Liu. Impact of adjuvant chemotherapy on survival for patients with completely resected stage T2bN0M0 non-small cell lung cancer[J/OL]. Chinese Journal of Thoracic Surgery(Electronic Edition), 2025, 12(01): 12-23.

目的

评估术后辅助化疗对R0切除T2bN0M0期非小细胞肺癌(NSCLC)患者生存的影响。

方法

回顾性分析SEER数据库中2010至2015年行肺叶切除+纵隔淋巴结清扫术的T2bN0M0期NSCLC患者的临床病理资料。通过倾向性评分匹配方法最小化混杂因素的影响,进一步采用Kaplan-Meier曲线和Cox比例风险模型评估术后辅助化疗对T2bN0M0期NSCLC患者的总生存期的影响。

结果

共纳入538例R0切除T2bN0M0期NSCLC患者,其中男285例,女253例,中位年龄69(62~75)岁。与未术后辅助化疗组相比较,术后辅助化疗组中年龄<70岁、组织学分化Ⅲ~Ⅳ级患者所占比例显著增高(P<0.05)。在Cox比例风险回归分析中,术后辅助化疗是T2bN0M0期NSCLC患者预后的保护因素(风险比=0.52,95%置信区间:0.36~0.74,P<0.05)。在总人群中,无论倾向性评分匹配前后,接受术后辅助化疗的T2bN0M0期NSCLC患者的OS均优于非辅助化疗患者(P<0.05)。除此以外,对于年龄<70岁的患者,辅助化疗可以带来生存获益,但对于年龄≥70岁的患者,辅助化疗不能提高患者的OS。同样的,对于低-未分化患者,辅助化疗可以提高患者OS,但对于中-高分化的患者,辅助化疗并不能带来生存获益。

结论

术后辅助化疗能改善R0切除T2bN0M0期NSCLC患者的总体生存期,尤其是对于年龄<70岁和低-未分化患者。推荐R0切除T2bN0M0期NSCLC患者术后行术后辅助化疗。

Objective

To estimate the impact of adjuvant chemotherapy on survival in T2bN0M0 nonsmall cell lung cancer(NSCLC)patients.

Methods

The clinicopathological data of patients with stage T2bN0M0 NSCLC who underwent lobectomy and mediastinal lymph node dissection between 2010 and 2015 were retrospectively analyzed in the Surveillance,Epidemiology,and End Results(SEER)database.The risk factors were identified by Cox regression.Propensity score matching(PSM)analysis and Kaplan-Meier curves were used to compare the cancerspecific survival(CSS)and overall survival(OS)of T2bN0M0 NSCLC patients between the non-adjuvant chemotherapy and adjuvant chemotherapy groups.

Results

A total of 538 patients with completely resected stage T2bN0M0 NSCLC were enrolled in this study,including 285 males and 253 females,with a median age of 69(62-75)years.Patients with younger,grade III-IV were more likely to receive chemotherapy(P<0.05).In Cox regression,adjuvant chemotherapy was significantly associated with OS in completely resected stage T2N0M0 NSCLC(hazard ratio =0.52,95% confidence interval 0.36-0.74,P<0.05).In the total population,patients treated with adjuvant chemotherapy had a better OS than those not treated with adjuvant chemotherapy before and after PSM(P<0.05).In addition,adjuvant chemotherapy can bring a survival benefit for patients <70 years old,but does not improve OS for patients≥70 years old.Similarly,for poor-to-undifferentiated patients,adjuvant chemotherapy can improve the OS of patients,but for moderate-to-well differentiated patients,adjuvant chemotherapy cannot bring survival benefit.

Conclusion

Adjuvant chemotherapy contribute to a survival benefit in completely resected stage T2bN0M0 NSCLC patients,especially in patients <70 years and poor-to-undifferentiated NSCLC patients.Adjuvant chemotherapy should be considered in completely resected stage T2bN0M0 NSCLC patients.

图1 研究设计流程图。经过严格的纳入条件筛选,最终纳入了538位行肺叶切除术联合纵隔淋巴结清扫,且肿瘤大小为(4,5] cm的T2bN0M0期非小细胞肺癌患者
表1 T2bN0M0期非小细胞肺癌患者的基线特征(倾向性匹配前)[例(%)]
表2 基于T2bN0M0期非小细胞肺癌患者总生存的Cox单因素和多因素分析
表3 T2bN0M0期非小细胞肺癌患者的基线特征(倾向性匹配后)[例(%)]
图2 倾向性匹配评分前后Kaplan-Meier生存曲线。A:倾向性评分匹配前;B:倾向性评分匹配后
表4 <70岁T2bN0M0期非小细胞肺癌患者PSM前、后的基线人口统计学特征[例(%)]
表5 ≥70岁T2bN0M0期非小细胞肺癌患者PSM前、后的基线人口统计学特征[例(%)]
表6 高-中分化T2bN0M0期非小细胞肺癌患者PSM前、后的基线人口统计学特征[例(%)]
续表6
表7 低-未分化T2bN0M0期非小细胞肺癌患者PSM前、后的基线人口统计学特征[例(%)]
图3 患者按年龄分层的Kaplan-Meier生存曲线。A:年龄<70岁,PSM前;B:年龄<70岁,PSM后;C:年龄≥70岁,PSM前;D:年龄≥70岁,PSM后。PSM:倾向性匹配
图4 患者按组织学分级分层的Kaplan-Meier生存曲线。A:中分化或高分化,PSM前;B:中分化或高分化,PSM后;C:低分化或未分化,PSM前;D:低分化或未分化,PSM后。PSM:倾向性匹配
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