原发灶手术对Ⅳ期非小细胞肺癌患者生存的影响

目的探讨Ⅳ期非小细胞肺癌(NSCLC)原发灶手术的价值及其相关预后因素。方法从美国国立癌症研究所监测、流行病学和最终结果数据库获取2010—2015年期间初诊Ⅳ期原发NSCLC患者的资料进行回顾性分析,纳入4 657例患者,采用倾向得分匹配减小手术组与非手术组的选择偏倚。利用Kaplan-Meier曲线计算纳入人群的总生存时间和肿瘤特异性生存时间,利用Log rank检验和Cox回归分析评估Ⅳ期NSCLC患者的预后影响因素。结果倾向得分匹配后,手术组(958例)和非手术组(958例)患者的中位生存时间分别为7和3个月,3年总生存率分别为14.6%和5.0%;3年肿瘤特异性生存率分别为17.3%和6.5%。多因素Cox回归分析结果显示,原发灶手术为Ⅳ期NSCLC患者独立的预后因素(P<0.001)。亚组分析结果显示,<80岁,白种人和黑种人,不同性别,原发灶位于肺上叶和交搭跨越处,中、低分化,腺癌,T1~2、T4期,N0、N2期,淋巴结未清扫,转移灶未手术,转移脏器个数<3个的Ⅳ期NSCLC患者接受原发灶手术后的3年总生存率和3年肿瘤特异性生存率均显著获益(均P<0.05)。结论选择性的对原发Ⅳ期NSCLC患者行原发灶手术,在特定的亚组中可显著改善患者预后。

Survival benefit of primary site surgery acquired by stageⅣnon-small cell lung cancer:a retrospective study based on seer database

Objective To investigate the value of primary site surgery in stageⅣnon-small cell lung cancer(NSCLC)and associated prognostic factors.Methods The data of stageⅣprimary non-small cell lung cancer initially diagnosed from 2010 to 2015 were collected from the Surveillance,Epidemiology,and End Results(SEER)database and retrospective analyzed.Propensity-matched analysis was performed to decrease the selection bias between surgery and non-surgery groups.Overall survival(OS)and cancer-specific survival(CSS)were calculated by Kaplan-Meier curves.Log rank test and Cox regression analyses were applied to evaluate the prognostic factors.Results A total of 4657 patients were recruited.In the matched population,the median OS of surgery and non-surgery groups were 7 and 3 months.The 3-years OS were 14.6%and 5.0%,respectively.The 3-years CSS were 17.3%and 6.5%,respectively.Univariate and multivariate analyses indicated primary lesion surgery was an independent prognostic factor for OS and CSS(P<0.001).Subgroup analysis showed that patients with stageⅣNSCLC who<80 years old,White and Black,gender,tumor located in the upper lobe and crossover,moderately and poorly differentiated,adenocarcinoma,T1-2 or T4 stage,N0 or N2,without regional lymph node dissection,without metastatic sites operation,and the number of metastatic organs<3,obtained a better 3-years OS and CSS from primary site surgery(P<0.05).Conclusion Primary site surgery can significantly improve the OS and CSS of patients with stageⅣNSCLC carefully selected.