作者：王秋桐，曹婷婷，周玮玮，王明，吴爽，赵瑞，姜俊杰

单位：

1.061001河北省沧州市，沧州医学高等专科学校 2.061001河北省沧州市中心医院病理科 3.061001河北省沧州市中心医院肿瘤科 4.100020北京市，首都医科大学附属北京朝阳医院药事部 5.061001河北省沧州市中心医院甲乳腺外一科 通信作者：姜俊杰，E-mail：2577081120@qq.com

Units：

1.Cangzhou Medical College·Hebei·China, Cangzhou 061001, China 2.Department of Pathology, Cangzhou Central Hospital, Cangzhou 061001, China 3.Department of Oncology, Cangzhou Central Hospital, Cangzhou 061001, China 4.Department of Pharmacy, Beijing Chao-yang Hospital, Capital Medical University, Beijing 100020, China 5.Department of Thyroid and Mammary Surgery, Cangzhou Central Hospital, Cangzhou 061001, China Corresponding author: JIANG Junjie, E-mail: 2577081120@qq.com

关键词：

癌,非小细胞肺; 非小细胞肺癌; 放化疗,辅助; 预后;

Keywords：

Carcinoma, non-small-cell lung; Non-small-cell lung carcinomas; Chemoradiotherapy, adjuvant;Prognosis

CLC：

DOI：

10.12114/j.issn.1008-5971.2022.00.053

Funds：

摘要：

背景手术切除是早期非小细胞肺癌(NSCLC)患者的首选治疗手段,但患者术后预后差异较大,其是否接受术后辅助化疗也存在争议。目的 分析术后辅助化疗对早期NSCLC患者预后的影响。方法 选取2013—2018年沧州市中心医院肿瘤科收治的早期NSCLC患者1 460例为研究对象。收集患者一般资料,统计患者术后辅助化疗情况、术后危险因素评分、生存情况、中位生存时间(mST)和5年生存率。根据患者接受术后辅助化疗情况,将其分为术后辅助化疗组(251例)和未术后辅助化疗组(1 209例)。由于术后辅助化疗组与未术后辅助化疗组患者例数相差较大,本研究采用倾向性评分匹配来减少基线数据对最终结果的影响,最终两组均纳入237例患者。根据474例患者预后情况,将其分为死亡组(102例)和存活组(372例)。早期NSCLC患者预后影响因素分析采用多因素Cox回归分析;使用Kaplan-Meier法绘制生存曲线。结果 多因素Cox回归分析结果显示,年龄为>65岁〔HR=3.386,95%CI(1.216,9.433)〕,性别〔HR=1.689,95%CI(1.154,2.472)〕,肿瘤分化程度为中、低分化〔中分化:HR=2.911,95%CI(1.281,6.614);低分化:HR=5.575,95%CI(1.867,16.645)〕及术后辅助化疗〔HR=1.575,95%CI(1.070,2.318)〕是早期NSCLC患者预后的独立影响因素(P<0.05)。术后辅助化疗组患者mST为85个月,长于未术后辅助化疗组的74个月(P<0.05)。术后辅助化疗组病理学分型为腺癌患者mST为86个月,长于未术后辅助化疗组的74个月(P<0.05);术后辅助化疗组病理学分型为腺癌患者5年生存率为80.8%,高于未术后辅助化疗组的69.1%(P<0.05)。术后辅助化疗组肿瘤直径为31～40 mm患者mST为76个月,长于未术后辅助化疗组的65个月(P<0.05);术后辅助化疗组肿瘤直径为31～40 mm患者5年生存率为82.3%,高于未术后辅助化疗组的56.1%(P<0.05)。术后辅助化疗组ⅠB期患者mST为86个月,长于未术后辅助化疗组的74个月(P<0.05);术后辅助化疗组ⅠB期患者5年生存率为81.0%,高于未术后辅助化疗组的70.9%(P<0.05)。术后辅助化疗组术后危险因素评分≥2分患者mST为79个月,长于未术后辅助化疗组的60个月(P<0.05);术后辅助化疗组术后危险因素评分≥2分患者5年生存率为77.6%,高于未术后辅助化疗组的47.6%(P<0.05)。结论 术后辅助化疗可以延长早期NSCLC患者的生存时间,尤其是病理学分型为腺癌、肿瘤直径为31～40 mm、ⅠB期、术后危险因素评分≥2分患者。

Abstract：

【Abstract】　Background Surgical resection is the first choice for patients with early non-small cell lungcancer (NSCLC) , but the postoperative prognosis of patients varies greatly, and whether they receive postoperative adjuvantchemotherapy is also controversial. Objective To analyze the effect of postoperative adjuvant chemotherapy on prognosis ofpatients with NSCLC. Methods A total of 1 460 patients with early NSCLC treated in the Department of Oncology of CangzhouCentral Hospital from 2013 to 2018 were selected as the research objects. The general data of the patients were collected, andthe postoperative adjuvant chemotherapy, postoperative risk factor scores, survival, median survival time (mST) and 5-yearsurvival rate were counted. According to postoperative adjuvant chemotherapy, patients were divided into postoperative adjuvantchemotherapy group (251 cases) and non postoperative adjuvant chemotherapy group (1 209 cases) . Due to the large difference inthe number of patients between the postoperative adjuvant chemotherapy group and the non postoperative adjuvant chemotherapygroup, propensity score matching was used in this study to reduce the influence of baseline data on the final results, and 237patients were finally included in both groups. According to the prognosis of 474 patients, they were divided into death group(102 cases) and survival group (372 cases) . Multivariate Cox regression analysis was used to analyze the influencing factors ofprognosis of patients with early stage NSCLC; survival curves were drawn using the Kaplan-Meier method. Results MultivariateCox regression analysis showed that age of > 65 years old [HR=3.386, 95%CI (1.216, 9.433) ] , gender [HR=1.689, 95%CI(1.154, 2.472) ] , moderate and low degree of tumor differentiation [medium differentiation: HR=2.911, 95%CI (1.281, 6.614) ; lowdifferentiation: HR=5.575, 95%CI (1.867, 16.645) ] , postoperative adjuvant chemotherapy [HR=1.575, 95%CI (1.070, 2.318) ]were independent influencing factors for the prognosis of early-stage NSCLC patients (P <0.05) . The mST in the postoperativeadjuvant chemotherapy group was 85 months, which was longer than 74 months in the non postoperative adjuvant chemotherapygroup (P <0.05) . The mST of patients with adenocarcinoma in the postoperative adjuvant chemotherapy group was 86 months,which was longer than 74 months in the non postoperative adjuvant chemotherapy group (P <0.05) ; the 5-year survival rate ofpatients with adenocarcinoma in the postoperative adjuvant chemotherapy group was 80.8%, which was higher than 69.1% inthe non postoperative adjuvant chemotherapy group (P <0.05) . The mST of patients with tumor diameter of 31-40 mm in thepostoperative adjuvant chemotherapy group was 76 months, which was longer than 65 months in the non postoperative adjuvantchemotherapy group (P <0.05) ; the 5-year survival rate of patients with tumor diameter of 31-40 mm in the postoperativeadjuvant chemotherapy group was 82.3%, which was higher than 56.1% in the non postoperative adjuvant chemotherapy group(P<0.05) . The mST of stage Ⅰ B patients in the postoperative adjuvant chemotherapy group was 86 months, which was longerthan 74 months in the non postoperative adjuvant chemotherapy group (P <0.05) ; the 5-year survival rate of stage Ⅰ B patientsin the postoperative adjuvant chemotherapy group was 81.0%, which was higher than 70.9% in the non postoperative adjuvantchemotherapy group (P <0.05) . The postoperative risk factor score ≥ 2 in the postoperative adjuvant chemotherapy group was 79months, which was longer than 60 months in the non postoperative adjuvant chemotherapy group (P <0.05) ; the 5-year survivalrate of patients with postoperative risk factor score ≥ 2 in the postoperative adjuvant chemotherapy group was 77.6%, whichwas higher than 47.6% in the non postoperative adjuvant chemotherapy group (P <0.05) . Conclusion Postoperative adjuvantchemotherapy can prolong the survival time of patients with early NSCLC, especially those with pathological classification ofadenocarcinoma, tumor diameter of 31-40 mm, stageⅠ B and postoperative risk factor score ≥ 2.

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