Background

Adjuvant chemotherapy demonstrated a clear benefit in resected non-small cell lung cancer (NSCLC) with nodal disease (stages II-III), and a minimal benefit in tumors >4 cm (stage II, TNM 8th edition). Pleural invasion (PL), classified as visceral pleural invasion (VPI, which includes PL1 and PL2, and parietal pleural invasion (PL3), is an established negative prognostic factor. However, whether PL should influence the decisional algorithm of postoperative chemotherapy is controversial.

Methods

A survival analysis of NSCLC patients who underwent radical surgery between 2010 and 2015 included in the SEER database was performed. Tumor stage and size, number of examined and positive nodes, histology, PL, and treatment data were extracted. Propensity score matching was performed. The benefit of chemotherapy was analyzed in two subgroups: standard of care (SOC), including patients with positive nodes or tumors ≥ 4 cm; non-SOC, including patients with tumors < 4 cm and negative nodes.

Results

Records of 30,858 patients were extracted. 11,708 patients were included in the propensity score-matched analysis. In the SOC subgroup, including 8089 patients, all pleural invasion degrees were associated with progressively increased risk for death and shorter overall survival (OS), independently from chemotherapy administration. However, chemotherapy significantly improved the median OS regardless of the extent of PL. In the non-SOC subgroup, including 3619 patients, only PL3 was associated with increased mortality. The administration of chemotherapy did not improve survival outcomes.

Conclusion

Chemotherapy should be strongly recommended in patients in the SOC-subgroup with pleural invasion. VPI is not associated with unfavorable prognosis in the non-SOC subgroup.

中文翻译：

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胸膜浸润与接受辅助治疗的切除 NSCLC 患者的预后相关性：SEER 数据库的倾向评分匹配分析

背景

辅助化疗在具有淋巴结疾病（II-III 期）的可切除非小细胞肺癌 (NSCLC) 中显示出明显的益处，而对大于 4 cm 的肿瘤（II 期，TNM 第 8 版）的益处最小。胸膜浸润（PL）被归类为脏层胸膜浸润（VPI，包括PL1和PL2，壁层胸膜浸润（PL3））是一个既定的负面预后因素。然而，PL是否应该影响术后化疗的决策方案是有争议的。

方法

对 SEER 数据库中包含的 2010 年至 2015 年间接受根治性手术的 NSCLC 患者进行了生存分析。提取肿瘤分期和大小、检查和阳性淋巴结的数量、组织学、PL 和治疗数据。进行了倾向评分匹配。在两个亚组中分析了化疗的益处：标准护理 (SOC)，包括阳性淋巴结或肿瘤 ≥ 4 cm 的患者；非 SOC，包括肿瘤 < 4 cm 和阴性淋巴结的患者。

结果

提取了 30,858 名患者的记录。11,708 名患者被纳入倾向评分匹配分析。在 SOC 亚组中，包括 8089 名患者，所有胸膜浸润程度均与死亡风险逐渐增加和总生存期 (OS) 缩短相关，独立于化疗给药。然而，无论 PL 的程度如何，化疗都显着改善了中位 OS。在包括 3619 名患者在内的非 SOC 亚组中，只有 PL3 与死亡率增加相关。化疗并没有改善生存结果。

结论

应强烈推荐 SOC 亚组胸膜侵犯患者进行化疗。VPI 与非 SOC 亚组的不良预后无关。