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Importance of tumour volume and histology in trimodality treatment of patients with Stage IIIA non-small cell lung cancer—results from a retrospective analysis
Interdisciplinary CardioVascular and Thoracic Surgery ( IF 1.978 ) Pub Date : 2021-10-16 , DOI: 10.1093/icvts/ivab291
Pieter J M Joosten 1 , Chris Dickhoff 2 , Vincent van der Noort 3 , Maarten Smeekens 4 , Rachel C Numan 1 , Houke M Klomp 1 , Judi N A van Diessen 5 , Jose S A Belderbos 5 , Egbert F Smit 6 , Kim Monkhorst 7 , Jan W A Oosterhuis 8 , Michel M van den Heuvel 6, 9 , Max Dahele 10 , Koen J Hartemink 1
Affiliation  

OBJECTIVES Chemoradiotherapy (CRT) has been the backbone of guideline-recommended treatment for Stage IIIA non-small cell lung cancer (NSCLC). However, in selected operable patients with a resectable tumour, good results have been achieved with trimodality treatment (TT). The objective of this bi-institutional analysis of outcomes in patients treated for Stage IIIA NSCLC was to identify particular factors supporting the role of surgery after CRT. METHODS In a 2-centre retrospective cohort study, patients with Stage III NSCLC (seventh edition TNM) were identified and those patients with Stage IIIA who were treated with CRT or TT between January 2007 and December 2013 were selected. Patient characteristics as well as tumour parameters were evaluated in relation to outcome and whether or not these variables were predictive for the influence of treatment (TT or CRT) on outcome [overall survival (OS) or progression-free survival (PFS)]. Estimation of treatment effect on PFS and OS was performed using propensity-weighted cox regression analysis based on inverse probability weighting. RESULTS From a database of 725 Stage III NSCLC patients, 257 Stage IIIA NSCLC patients, treated with curative intent, were analysed; 186 (72%) with cIIIA-N2 and 71 (28%) with cT3N1/cT4N0 disease. One hundred and ninety-six (76.3%) patients were treated by CRT alone (high-dose radiation with daily low-dose cisplatin) and 61 (23.7%) by TT. The unweighted data showed that TT resulted in better PFS and OS. After weighting for factors predictive of treatment assignment, patients with a large gross tumour volume (>120 cc) had better PFS when treated with TT, and patients with an adenocarcinoma treated with TT had better OS, regardless of tumour volume. CONCLUSIONS Patients with Stage IIIA NSCLC and large tumour volume, as well as patients with adenocarcinoma, who were selected for TT, had favourable outcome compared to patients receiving CRT. This information can be used to assist multidisciplinary team decision-making and for stratifying patients in studies comparing TT and definitive CRT.

中文翻译:

肿瘤体积和组织学在 IIIA 期非小细胞肺癌患者三联治疗中的重要性——回顾性分析的结果

目标 放化疗 (CRT) 一直是指南推荐的 IIIA 期非小细胞肺癌 (NSCLC) 治疗的支柱。然而,在选定的可手术切除的肿瘤患者中,三联治疗(TT)取得了良好的效果。这项对 IIIA 期 NSCLC 患者结局的双机构分析的目的是确定支持 CRT 后手术作用的特定因素。方法 在一项 2 中心回顾性队列研究中,确定了 III 期 NSCLC(第 7 版 TNM)患者,并选择了 2007 年 1 月至 2013 年 12 月期间接受 CRT 或 TT 治疗的 IIIA 期患者。评估与结果相关的患者特征和肿瘤参数,以及这些变量是否可以预测治疗(TT 或 CRT)对结果的影响 [总生存期 (OS) 或无进展生存期 (PFS)]。使用基于逆概率加权的倾向加权 cox 回归分析估计治疗对 PFS 和 OS 的影响。结果 从包含 725 名 III 期 NSCLC 患者的数据库中,分析了 257 名接受治愈性治疗的 IIIA 期 NSCLC 患者;186 人 (72%) 患有 cIIIA-N2,71 人 (28%) 患有 cT3N1/cT4N0 疾病。196 名 (76.3%) 患者单独接受 CRT(大剂量放疗,每日低剂量顺铂),61 名(23.7%)患者接受 TT。未加权数据显示 TT 导致更好的 PFS 和 OS。在对预测治疗分配的因素进行加权后,大体肿瘤体积 (>120 cc) 的患者在接受 TT 治疗时具有更好的 PFS,而接受 TT 治疗的腺癌患者具有更好的 OS,无论肿瘤体积如何。结论 与接受 CRT 的患者相比,选择接受 TT 的 IIIA 期 NSCLC 和大肿瘤体积的患者以及腺癌患者具有良好的结果。该信息可用于协助多学科团队决策,并在比较 TT 和确定性 CRT 的研究中对患者进行分层。结论 与接受 CRT 的患者相比,选择接受 TT 的 IIIA 期 NSCLC 和大肿瘤体积的患者以及腺癌患者具有良好的结果。该信息可用于协助多学科团队决策,并在比较 TT 和确定性 CRT 的研究中对患者进行分层。结论 与接受 CRT 的患者相比,选择接受 TT 的 IIIA 期 NSCLC 和大肿瘤体积的患者以及腺癌患者具有良好的结果。该信息可用于协助多学科团队决策,并在比较 TT 和确定性 CRT 的研究中对患者进行分层。
更新日期:2021-10-16
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