作者：王瀚森，姜俊杰，王明，吴爽，陈玲，赵瑞，王秋桐

单位：

1.河北省沧州市妇幼保健院病理科2.河北省沧州市中心医院甲乳外一科3.河北省沧州市中心医院肿瘤科4.沧州医学高等专科学校5.首都医科大学附属北京朝阳医院药事部

Units：

Department of Pathology, Cangzhou City Maternal and Child Health Hospital;Department of Thyroid and Mammary Surgery, Cangzhou Central Hospital;Department of Oncology, Cangzhou Central Hospital;Cangzhou Medical College;Department of Pharmacy, Beijing Chao-yang Hospital, Capital Medical University;

关键词：

癌,非小细胞肺; ⅠB期; 术后辅助化疗; 复发; 危险因素; 无复发生存期;

Keywords：

Carcinoma,non-small-cell lung;Stage ⅠB;Postoperative adjuvant chemotherapy;Recurrence;Risk factors;Recurrence free survival;

CLC：

DOI：

10.12114/j.issn.1008-5971.2022.00.293

Funds：

摘要：

目的 探讨术后辅助化疗对伴有复发危险因素的ⅠB期非小细胞肺癌（NSCLC）患者复发的影响。方法 选取2016年1月至2019年1月沧州市中心医院肿瘤科收治的ⅠB期NSCLC患者380例。收集患者的临床资料[包括年龄、性别、肿瘤原发位置、肿瘤分化程度、病理学分型、手术类型、肿瘤直径、淋巴结清扫数量、美国东部肿瘤协作组（ECOG）评分、术后辅助化疗情况、胸膜浸润情况、吸烟史、脉管癌栓（分为血管癌栓和淋巴管癌栓）及合并脑血管病、心血管病、糖尿病、高血压情况]及无复发生存期（RFS）、无复发生存率。采用多因素Logistic回归分析探讨ⅠB期NSCLC患者复发的影响因素，采用Kaplan-Meier法绘制生存曲线。结果 380例患者中有194例复发，将其作为复发组，其余为无复发组。多因素Logistic回归分析结果显示，术后辅助化疗是ⅠB期NSCLC患者复发的保护因素，脉管癌栓、合并脑血管病是ⅠB期NSCLC患者复发的危险因素（P<0.05）。伴有复发危险因素（发生脉管癌栓、合并脑血管病）的ⅠB期NSCLC患者共238例，根据是否接受术后辅助化疗分为辅助化疗组（n=190）和未辅助化疗组（n=48）。辅助化疗组mRFS长于未辅助化疗组（P<0.05）。辅助化疗组3年、5年累积无复发生存率高于未辅助化疗组（P<0.05）。接受术后辅助化疗的伴有脉管癌栓的ⅠB期NSCLC患者（n=44）mRFS与未接受术后辅助化疗患者（n=31）相等，差异无统计学意义（P=0.330）。对伴有脉管癌栓ⅠB期NSCLC患者进行亚组分析，结果显示，接受术后辅助化疗的伴有血管癌栓的ⅠB期NSCLC患者（n=22）mRFS短于伴有淋巴管癌栓的患者（n=22）(P<0.05)。接受术后辅助化疗的合并脑血管病的ⅠB期NSCLC患者（n=30）mRFS长于未接受术后辅助化疗患者（n=19）(P<0.05)。对伴有复发危险因素数量进行统计，伴有0个危险因素患者142例，伴有1个危险因素患者178例，伴有2个危险因素患者60例。伴有0个危险因素的ⅠB期NSCLC患者mRFS长于伴有2个危险因素的患者，5年累积无复发生存率低于伴有1个危险因素的患者（P<0.05）。此外，接受术后辅助化疗的伴有2个危险因素的ⅠB期NSCLC患者（n=56）mRFS长于未接受术后辅助化疗患者（n=4）(P<0.05)。结论 术后辅助化疗可延长ⅠB期NSCLC患者尤其是伴有复发危险因素患者的mRFS。

Abstract：

Objective To investigate the effect of postoperative adjuvant chemotherapy on the recurrence of stage ⅠB non-small cell lung cancer（NSCLC） patients with risk factors for recurrence. Methods A total of 380 patients with stage ⅠB NSCLC who were admitted to the Department of Oncology of Cangzhou Central Hospital from January 2016 to January 2019 were selected. The clinical data [including age, gender, primary tumor location, tumor differentiation, pathological classification, surgical type, tumor diameter, number of lymph node dissection, Eastern Cooperative Oncology Group（ECOG） score, postoperative adjuvant chemotherapy, pleural infiltration, smoking history, vascular tumor thrombus（including vascular tumor thrombus and lymphatic tumor thrombus） and cerebrovascular disease, cardiovascular disease, diabetes, hypertension] and recurrence free survival（RFS）, recurrence-free survival rate of patients were collected. Multivariate Logistic regression analysis was used to explore the influencing factors of recurrence in patients with stage ⅠB NSCLC. Kaplan-Meier method was used to draw the survival curve. Results Among 380 patients, 194 relapsed and were classified as the relapse group and the rest as the no recurrence group. Multivariate Logistic regression analysis showed that postoperative adjuvant chemotherapy was a protective factor for recurrence in patients with stage ⅠB NSCLC, while vascular tumor thrombus and cerebrovascular disease were risk factors for recurrence in patients with stage ⅠB NSCLC（P < 0.05）. A total of 238 ⅠB NSCLC patients with recurrence risk factors（combined with vascular tumor thrombus and cerebrovascular disease） were divided into adjuvant chemotherapy group（n=190） and nonadjuvant chemotherapy group（n=48） according to whether they received postoperative adjuvant chemotherapy or not. The mRFS of patients in the adjuvant chemotherapy group was longer than that in the non-adjuvant chemotherapy group（P < 0.05）. The 3-year and 5-year cumulative recurrence-free survival rates in the adjuvant chemotherapy group were higher than those in the nonadjuvant chemotherapy group（P < 0.05）. The mRFS of stage ⅠB NSCLC patients with vascular tumor thrombus who underwent postoperative adjuvant chemotherapy（n=44） was equal to that of patients without postoperative adjuvant chemotherapy（n=31）, and the difference was not statistically significant（P=0.330）. A subgroup analysis of patients with vascular tumor thrombus showed that the mRFS of patients with stage ⅠB NSCLC with vascular tumor thrombus（n=22） who underwent postoperative adjuvant chemotherapy was shorter than that of patients with lymphatic tumor thrombus（n=22）（P <0.05）. The mRFS of stage ⅠB NSCLC patients with cerebrovascular disease who underwent postoperative adjuvant chemotherapy（n=30） was longer than that of patients without postoperative adjuvant chemotherapy（n=19）（P < 0.05）. The number of patients with recurrence risk factors was counted. There were 142 patients with 0 risk factors, 178 patients with 1 risk factor, and 60 patients with 2 risk factors. The mRFS of patients with stage ⅠB NSCLC with 0 risk factors was longer than that of patients with 2 risk factors, and the 5-year cumulative recurrence-free survival rate was lower than that of patients with 1 risk factor（P < 0.05）. In addition, the mRFS of patients with stage ⅠB NSCLC with 2 risk factors（n=56） who underwent postoperative adjuvant chemotherapy was longer than that of the patients without postoperative adjuvant chemotherapy（n=4）（P < 0.05）. Conclusion Postoperative adjuvant chemotherapy can prolong the mRFS of stage ⅠB NSCLC patients especially the patients with recurrence risk factors.

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