SCI
17 August 2024
Recurrence of Non–Small Cell Lung Cancer With Visceral Pleural Invasion
A Secondary Analysis of a Randomized Clinical Trial
(JAMA Oncology, IF: 22.5)
Nasser Altorki, Xiaofei Wang, Bryce Damman, David R. Jones, Dennis Wigle, Jeffrey Port, Massimo Conti, Ahmad S. Ashrafi, Moishe Lieberman, Rodney Landreneau, Kazuhiro Yasufuku, Stephen Yang, John D. Mitchell, Robert Keenan, Thomas Bauer, Daniel Miller, David Kozono, Jennifer Mentlick; Everett Vokes, Thomas E. Stinchcombe
CORRESPONDENCE TO: nkaltork@med.cornell.edu
The randomized clinical trial Cancer and Leukemia Group B (CALGB) 140503 showed that for patients with clinically staged T1N0 non–small cell lung cancer (NSCLC; 2 cm), sublobar resections were associated with similar oncological outcomes to those after lobar resection. The association of the extent of parenchymal resection with recurrence and survival in patients with tumors pathologically upstaged to T2 based on visceral pleural invasion (VPI) is controversial.
癌症和白血病B组（CALGB）140503的随机临床试验表明，对于临床分期为T1N0非小细胞肺癌（NSCLC；2 cm）的患者，肺叶切除与亚肺叶切除的肿瘤预后结果相似。对于基于脏层胸膜侵犯（VPI）而在病理学上升期至T2的肿瘤患者，实质切除程度与肿瘤复发和肿瘤患者术后生存率的关系存在争议。
To determine survival and recurrence rates in patients with small peripheral pT2 NSCLC (2 cm) that was treated by either lobar or sublobar resection in CALGB 140503.
确定CALGB 140503中接受肺叶切除或亚肺叶切除术治疗的小型外周pT2 NSCLC（2cm）肺癌患者的生存率和复发率。
CALGB 140503, a randomized multicenter noninferiority trial, included 697 patients with small peripheral NSCLC that was clinically staged as T1N0. Enrollment was from June 2007 through March 2017 at 83 participating institutions, and after a median follow-up of 7 years, the primary outcome of disease-free survival after sublobar resection was noninferior to that after lobar resection.
CALGB 140503是一项随机多中心非劣效性试验，包括697名临床分期为T1N0的小型外周非小细胞肺癌患者。试验入组时间为2007年6月至2017年3月，共有83家参与机构，经过中位随访时间为7年的随访，主要结果亚肺叶切除术无病生存率并不劣于肺叶切除术的无病生存率。
Lobar or sublobar resection.
肺叶切除或亚肺叶切除术。
Survival end points were estimated by the Kaplan-Meier estimator. Hazard ratios and 95% CIs were estimated using stratified Cox proportional hazard models.
生存终点采用Kaplan-Meier估计法进行估计。使用分层Cox比例风险模型估计风险比和95%置信区间。
Of 679 participants, 390 (57.4%) were female, and the median (range) age was 67.8 (37.8-89.7) years. Among 697 patients randomized, 566 (81.2%) had pT1 tumors (no VPI) and 113 (16.2%) had pT2 tumors (VPI). Five-year disease-free survival was 65.9% (95%CI, 61.9%-70.2%) in patients with pT1 compared with 53.3% (95%CI, 44.3%-64.1%) in patients with pT2 tumors (stratified log-rank: P = .02). Disease recurrence developed in 27.6%of patients with pT1 (locoregional only: 60 [10.8%]; distant only: 81 [14.6%]) and 41.6%of those with pT2 (locoregional only: 17 [15.0%]; distant only: 27 [23.9%]). Five-year recurrence-free survival was 73.1% (95%CI, 69.2%-77.1%) for pT1 tumors and 58.2% (95%CI, 49.2%-68.8%) for pT2 tumors (stratified log-rank: P = .01). There were no intergroup differences in disease-free or recurrence-free survival based on the extent of parenchymal resection.
在679名参与者中，390名（57.4%）是女性，中位年龄（范围）为67.8（37.8-89.7）岁。在697名随机分组的患者中，566名（81.2%）患有pT1肿瘤（无VPI），113名（16.2%）患有pT2肿瘤（VPI）。pT1患者的五年无病生存率为65.9%（95%CI，61.9%-70.2%），而pT2肿瘤患者的五年无病生存率为53.3%（95%CI44.3%-64.1%）（分层对数秩：P=0.02）。27.6%的pT1患者（仅局部复发：60[10.8%]；仅远处复发：81[14.6%]）和41.6%的pT2患者（仅局部复发：17[15.0%]；仅有远处复发：27[23.9%]）出现了疾病复发。pT1肿瘤患者的五年无复发生存率为73.1%（95%CI，69.2%-77.1%），pT2肿瘤患者的五年无复发生存率为58.2%（95%CI，49.2%-68.8%）（分层对数秩：P=0.01）。根据实质切除的程度，组间无病或无复发生存率没有差异。
The results of this secondary analysis suggest that compared with patients with tumors without VPI, patients who had tumors with VPI had worse disease-free and recurrence-free survival and a higher rate of local and distant disease recurrence. These high rates of recurrence were independent of the extent of parenchymal resection, and these data support the inclusion of these patients in adjuvant therapy trials.
这项二次分析的结果表明，与没有VPI的肿瘤患者相比，患有VPI的患者的无病生存率和无复发生存率更低，局部和远处疾病复发率更高。这些高复发率与实质切除的程度无关，这些数据支持将这些患者纳入辅助治疗试验。
