原標題：Neoadjuvant Chemotherapy-alone vs Chemoradiation followed by Sleeve Resection for Locally Advanced Non-Small Cell Lung Cancer

Introduction

Traditionally, neoadjuvant chemoradiation is followed by surgery in patients with locally advanced resectable non-small cell lung cancer (NSCLC). The risks and benefits of this approach are not well defined in patients requiring a sleeve lung resection. In this context, we compare the short- and long-term outcomes of neoadjuvant chemotherapy-alone versus chemoradiation followed by sleeve lung resection.

摘要

傳統上，對於局部晚期可切除的非小細胞肺癌(NSCLC)患者，一般在新輔助放化療後進行手術治療。對於需要袖狀肺切除術的患者，這種方法的風險和好處還沒有明確定義。在此背景下，我們比較了單獨新輔助化療和同步放化療後肺袖狀切除術的短期和長期結果。

Methods

We used the National Cancer Database to identify locally advanced NSCLC patients who received either chemotherapy-alone or chemoradiation in the neoadjuvant setting followed by a sleeve lung resection between 2006 and 2017. Our outcomes of interest were 30-day mortality, 90 day mortality, and overall survival. To minimize confounding by indication, we used propensity score adjustment, logistic regression, Kaplan-Meier survival analysis, and Cox proportional hazards models to identify associations.

研究方法：

我們使用美國國家癌症數據庫(National Cancer Database)，確定了2006年至2017年期間在新輔助治療中接受單獨化療或放化療後進行袖狀肺切除術的局部晚期NSCLC患者。我們感興趣的結果是30天死亡率，90天死亡率和總生存率。為了盡量減少因適應症造成的混淆，我們使用傾向評分調整、logistic回歸、Kaplan-Meier生存分析和Cox比例風險模型來識別相關性。

Results

Of 176 total patients, 92 (54.9%) received neoadjuvant chemotherapy-alone and 84 (45.1%) received neoadjuvant chemoradiation. Patients in both groups were well balanced in terms of age, sex, race, Charlson-Deyo comorbidity index, insurance status, median income, and education (all p>0.05). Similarly, the groups were well balanced in terms of tumor histology, and stage (all p>0.05).

Patients receiving neoadjuvant chemoradiation had similar 30-day mortality (0% vs 2.2%; p=0.179), but higher 90-day mortality (11.96% vs 2.38%, P=0.015), and there was no difference in overall survival between patients receiving neoadjuvant chemoradiation compared to chemotherapy-alone (Figure; p=0.621). On multivariable analysis, neoadjuvant chemoradiation was associated with higher 90 day mortality (aOR=6.2; p<0.027) and not associated with overall survival (aHR=1.1 p=0.729).

結果：

在176例患者中，92例(54.9%)接受了新輔助化療，84例(45.1%)接受了新輔助放化療。兩組患者在年齡、性別、種族、charson - deyo共病指數、保險狀況、中位收入和教育程度方麵均達到良好平衡(均p>0.05)。同樣，兩組在腫瘤組織學和分期方麵也很平衡(均p>0.05)。接受新輔助放化療的患者30天死亡率相似(0% vs 2.2%;p=0.179)，但90天死亡率更高(11.96% vs 2.38%， p= 0.015)，接受新輔助放化療的患者與單獨化療的患者的總生存期無差異(圖;p = 0.621)。多變量分析顯示，新輔助放化療與較高的90天死亡率相關(aOR=6.2;p<0.027)，且與總生存率無關(aHR=1.1, p=0.729)。

Conclusion

In this first national study of patients with locally advanced resectable NSCLC requiring a sleeve lung resection, neoadjuvant chemoradiation was associated with a 5-fold increase in 90-day mortality without an overall survival benefit over neoadjuvant chemotherapy-alone.

結論：

在這項首次針對需要袖狀肺切除術的局部晚期可切除NSCLC患者的全國性研究中，新輔助放化療與單純新輔助化療相比，90天死亡率增加5倍，但總體生存期沒有增加。