辅助化疗对ⅠB期非小细胞肺癌患者预后的影响

Adjuvant chemotherapy versus observation in patients with resected stageⅠB non-small cell lung cancer

目的ⅠB期NSCLC患者术后是否需要行辅助化疗存在较大争议。本研究旨在探索辅助化疗对伴或不伴高危因素的ⅠB期NSCLC患者预后的影响。方法通过使用SEER*stat Version 8.4.0.1软件,我们从SEER Research Plus数据库中选择2010-2015年的NSCLC患者。根据本研究纳入排除标准,最终筛选出2018例接受手术的ⅠB期NSCLC,其中包括接受术后辅助化疗254例。采用Cox比例风险回归分析评估潜在预后风险因素。通过采用倾向评分匹配和Kaplan-Meier生存曲线评估辅助化疗对ⅠB期非小细胞肺癌患者肿瘤特异生存期(cancer-specific survival,CSS)的影响。进一步通过Kaplan-Meier生存曲线评估辅助化疗对伴或不伴高危因素的ⅠB期非小细胞肺癌患者CSS的影响。结果在接受手术的ⅠB期NSCLC患者中,未化疗组与化疗组组间的患者CSS(单因素分析:HR=0.934,95%CI:0.724~1.205,P=0.599;多因素分析:HR=0.935,95%CI:0.721~1.213,P=0.612)差异均无统计学意义。辅助化疗未明显延长伴或不伴仅单个高危因素(低分化肿瘤、脏层胸膜受累、亚肺叶切除和清扫不足10个淋巴结)以及伴2个及以上高危因素的ⅠB期NSCLC患者的CSS(P>0.05)。采用倾向性匹配法前后,未化疗组与化疗组组间接受手术的ⅠB期NSCLC患者的CSS差异无统计学意义(P>0.05)。结论辅助化疗未明显改善伴或不伴高危因素的ⅠB期NSCLC患者的肿瘤特异生存期。

Objective The role of adjuvant chemotherapy in survival in patients with resected stageⅠB NSCLC remains controversial.Therefore,this study aims to assess the association between adjuvant chemotherapy and survival in resected stageⅠB NSCLC patients with or without high-risk clinicopathological features.Methods This study population was chosen from the Surveillance,Epidemiology,and End Results database(SEER)Research Plus Database using SEER*stat Version 8.4.0.1 software.Finally,2018 cases with resected stageⅠB NSCLC were eligible for inclusion(Figure 1),of which 254 cases had received the adjuvant chemotherapy treatment.The Cox proportional hazards regression analysis was performed to evaluate potential prognostic factors for cancer special survival(CSS)outcomes in resected stageⅠB NSCLC.To balance baseline characteristics between the non-adjuvant chemotherapy group and adjuvant chemotherapy group,propensity score matching(PSM)with 1:1 propensity nearest-neighbor match by 0.02 matching tolerance was conducted by R software.Furthermore,propensity score matching(PSM)and Kaplan-Meier curve was conducted to compare the CSS between the non-adjuvant chemotherapy group and the adjuvant chemotherapy group.Furthermore,Kaplan-Meier curve was performed to assess the association between adjuvant chemotherapy and survival in resected stageⅠB NSCLC patients with or without high-risk clinicopathological features.Results Adjuvant chemotherapy was not significantly associated with CSS(univariate:HR=0.934,95%CI:0.724-1.205,P=0.599;multivariate:HR=0.935,95%CI:(0.721-1.213),P=0.612)in all resected stageⅠB NSCLC patients.Before and after PSM,CSS did differ significantly between the non-adjuvant chemotherapy group and adjuvant chemotherapy group(P>0.05).Adjuvant chemotherapy did not contribute to a CSS benefit in patients with resected stageⅠB NSCLC with or without high-risk clinicopathological features(P>0.05).Conclusion Adjuvant chemotherapy could not significantly improve CSS in patients with resected stageⅠB NSCLC without or with high-risk clinicopathological features.