PO.CL02.01 · 临床研究
围手术期化疗对I-II期大细胞肺癌患者的临床获益：一项SEER数据库分析
Clinical benefits of perioperative chemotherapy for patients with stage I-II large cell lung cancer: A SEER database analysis
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摘要 Abstract
中文摘要
背景：大细胞肺癌（LCLC）是非小细胞肺癌的一种神经内分泌亚型，仍是一种治疗选择有限的侵袭性恶性肿瘤。即使是早期疾病，切除后也显示出高复发率和不理想的生存。指导围手术期化疗（CTx）在I-II期LCLC中作用的证据有限。本研究使用具有全国代表性的数据集评估了围手术期CTx与手术切除LCLC生存结局之间的关联。
方法：从监测、流行病学和最终结果项目（SEER）17个登记处识别出2000-2021年间诊断的I-II期LCLC患者。纳入标准为病理确诊的LCLC、手术切除和美国癌症联合委员会（AJCC）第7版/第8版分期。收集了人口统计学、临床病理学和社会经济学变量。使用Kaplan-Meier分析比较单纯手术与手术加围手术期CTx之间的总生存期（OS）和癌症特异性生存期（CSS）。进行多变量Cox回归以识别II期LCLC中CSS的独立预测因素。
结果：共有1,894名患者符合纳入标准，包括489名接受新辅助和/或辅助CTx的患者。接受新辅助和/或辅助CTx的患者更年轻（中位65对70岁，p<0.001），T和N分期更晚，且更常处于晚期（p<0.001）。各组之间社会经济因素无显著差异。围手术期CTx与改善的CSS（风险比[HR] 0.71，95%置信区间[CI] 0.60-0.85，p<0.001）和OS（HR 0.67，95% CI 0.58-0.78，p<0.001）显著相关，在淋巴结受累患者中获益更为明显。在II期LCLC的多变量分析中，围手术期CTx独立预测更好的CSS（HR 0.79，95% CI 0.57-0.86，p<0.001）；年龄超过75岁（HR 1.76）、男性（HR 1.26）和N1淋巴结状态（HR 2.10）也与更高的死亡率相关。
结论：在这一大型SEER队列中，新辅助和/或辅助化疗与手术切除I-II期LCLC患者显著改善的癌症特异性生存相关，在淋巴结疾病患者中观察到最大获益。尽管有关手术范围和纵隔淋巴结清扫的信息有限，但这些发现支持在早期LCLC中考虑围手术期CTx，并强调了开展前瞻性研究以确定最佳治疗策略的必要性。
查看英文原文 English abstract
Background: Large cell lung cancer (LCLC), a neuroendocrine subtype of non-small cell lung cancer, remains an aggressive malignancy with limited therapeutic options. Even early-stage disease shows high recurrence rates and suboptimal survival after resection. Evidence guiding the role of perioperative chemotherapy (CTx) in stage I-II LCLC is limited. This study evaluated the association between perioperative CTx and survival outcomes in surgically resected LCLC using a nationally representative dataset.
Methods: Patients with stage I-II LCLC diagnosed between 2000-2021 were identified from the Surveillance, Epidemiology, and End Results Program (SEER) 17 registries. Inclusion criteria were pathologically confirmed LCLC, surgical resection, and American Joint Committee on Cancer (AJCC) 7th/8th edition staging. Demographic, clinicopathologic, and socioeconomic variables were collected. Overall survival (OS) and cancer-specific survival (CSS) were compared between surgery alone and surgery plus perioperative CTx using Kaplan-Meier analysis. Multivariable Cox regression was performed to identify independent predictors of CSS among stage II LCLC.
Results: A total of 1,894 patients met inclusion criteria, including 489 who received neoadjuvant and/or adjuvant CTx . Patients receiving neoadjuvant and/or adjuvant CTx were younger (median 65 vs. 70 years, p<0.001), had more advanced T and N stages, and more frequently had advanced stages (p<0.001). Socioeconomic factors were not significantly different between groups. Perioperative CTx was significantly associated with improved CSS (Hazard ratio (HR) 0.71, 95% confidence interval (CI) 0.60-0.85, p<0.001) and OS (HR 0.67, 95% CI 0.58-0.78, p<0.001) with a more pronounced benefit among patients with nodal involvement. On multivariable analysis among stage II LCLC, perioperative CTx independently predicted better CSS (HR 0.79, 95% CI 0.57-0.86, p<0.001); age over 75 (HR 1.76), male sex (HR 1.26), and N1 nodal status (HR 2.10) were also associated with higher mortality.
Conclusions: In this large SEER cohort, neoadjuvant and/or adjuvant chemotherapy was associated with significantly improved cancer-specific survival in patients with resected stage I-II LCLC, with the greatest benefit observed among patients with nodal disease. Although information on surgical extent and mediastinal lymph node dissection was limited, these findings support consideration of perioperative CTx for early-stage LCLC and underscore the need for prospective studies to define optimal treatment strategies.
利益披露 Disclosure
W. Woo, None..
S. Kim, None..
J. Kim, None..
D. Moon, None..
S. Lee, None.