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Abstract：
BACKGROUND: The use of adjuvant chemotherapy (ACT) in completely resected stage IB NSCLC is still controversial. This study aims to investigate the efficacy of ACT in pathological stage IB non-small cell lung cancer (NSCLC) with high risk factors.
METHODS: Patients with pT2aN0M0 stage IB NSCLC who underwent complete resection from 2013 to 2017 were retrospectively analyzed. Univariate and multivariable logistic regression analysis was used to assess potential independent risk factors associated with poor prognosis. To compare survival between patients who received ACT and those who did not.
RESULTS: In univariate and multivariate analyses, adenocarcinomas with predominantly micropapillary (MIP) and solid patterns (SOL), poorly differentiated squamous cell carcinoma (SCC), number of lymph nodes dissected less than 16 and tumor size larger than 36 mm were identified as high-risk factors for recurrence. In patients with high risk factors for recurrence, ACT resulted in significantly longer DFS (HR, 0.4689, 95%CI, 1.193-3.818; p = 0.0108) and OS (HR, 0.4696, 95%CI, 0.6578-6.895; p = 0.2073), although OS failed to reach statistically significance. After propensity score matching (PSM), 67 pairs of patients were 1:1 matched in the two groups and all baseline characteristics were well balanced. The results also demonstrated that ACT was associated with improved DFS (HR, 0.4776, 95%CI, 0.9779-4.484; p = 0.0440) while OS was not significantly different (92.5% vs. 91.0%; HR, 0.6167, 95%CI, 0.1688-2.038; p = 0.7458). In patients with low-risk factors for recurrence, DFS (HR, 0.4831, 95%CI, 0.03025-7.715; p = 0.6068) and OS (HR, 0.969, 95%CI, 0.08364-11.21; p = 0.9794) was not significantly different between those who received ACT and those who did not.
CONCLUSIONS: In patients with completely resected stage IB NSCLC, ACT can improve survival in patients with high risk for recurrence. Further large multicenter studies are needed to confirm these findings.
METHODS: Patients with pT2aN0M0 stage IB NSCLC who underwent complete resection from 2013 to 2017 were retrospectively analyzed. Univariate and multivariable logistic regression analysis was used to assess potential independent risk factors associated with poor prognosis. To compare survival between patients who received ACT and those who did not.
RESULTS: In univariate and multivariate analyses, adenocarcinomas with predominantly micropapillary (MIP) and solid patterns (SOL), poorly differentiated squamous cell carcinoma (SCC), number of lymph nodes dissected less than 16 and tumor size larger than 36 mm were identified as high-risk factors for recurrence. In patients with high risk factors for recurrence, ACT resulted in significantly longer DFS (HR, 0.4689, 95%CI, 1.193-3.818; p = 0.0108) and OS (HR, 0.4696, 95%CI, 0.6578-6.895; p = 0.2073), although OS failed to reach statistically significance. After propensity score matching (PSM), 67 pairs of patients were 1:1 matched in the two groups and all baseline characteristics were well balanced. The results also demonstrated that ACT was associated with improved DFS (HR, 0.4776, 95%CI, 0.9779-4.484; p = 0.0440) while OS was not significantly different (92.5% vs. 91.0%; HR, 0.6167, 95%CI, 0.1688-2.038; p = 0.7458). In patients with low-risk factors for recurrence, DFS (HR, 0.4831, 95%CI, 0.03025-7.715; p = 0.6068) and OS (HR, 0.969, 95%CI, 0.08364-11.21; p = 0.9794) was not significantly different between those who received ACT and those who did not.
CONCLUSIONS: In patients with completely resected stage IB NSCLC, ACT can improve survival in patients with high risk for recurrence. Further large multicenter studies are needed to confirm these findings.
摘要：
背景：在完全切除的IB期NSCLC中使用辅助化疗（ACT）仍然存在争议。本研究旨在探讨ACT在具有高危因素的病理分期IB期非小细胞肺癌(NSCLC)中的疗效。
方法：对2013年至2017年接受完全切除的pT2aN0M0期IB期NSCLC患者进行回顾性分析。采用单因素和多因素logistic回归分析评估与不良预后相关的独立危险因素。比较接受ACT和未接受ACT的患者的生存率。
结果：在单变量和多变量分析中，以微乳头状（MIP）和固体模式（SOL）为主的腺癌，低分化鳞状细胞癌（SCC），淋巴结清扫数小于16个,肿瘤大小大于36mm是复发的高危因素.在具有复发高危因素的患者中，ACT导致DFS显著延长(HR，0.4689，95CI，1.193-3.818；p=0.0108）和OS（HR，0.4696，95CI，0.6578-6.895；p=0.2073），尽管OS未能达到统计学意义。在倾向得分匹配(PSM)之后，两组中有67对患者为1：1匹配，所有基线特征均平衡。结果还表明，ACT与改善的DFS(HR，0.4776，95CI，0.9779-4.484；p=0.0440），而OS没有显着差异（92.5％与91.0%；HR，0.6167，95CI，0.1688-2.038；p=0.7458）。在低风险因素复发的患者中，DFS(HR,0.4831，95CI，0.03025-7.715；p=0.6068）和OS（HR，0.969，95CI，0.08364-11.21；p=0.9794）在接受ACT的人和未接受ACT的人之间没有显着差异。
结论：在完全切除的IB期NSCLC患者中，ACT可以提高复发风险高的患者的生存率。需要进一步的大型多中心研究来证实这些发现。
方法：对2013年至2017年接受完全切除的pT2aN0M0期IB期NSCLC患者进行回顾性分析。采用单因素和多因素logistic回归分析评估与不良预后相关的独立危险因素。比较接受ACT和未接受ACT的患者的生存率。
结果：在单变量和多变量分析中，以微乳头状（MIP）和固体模式（SOL）为主的腺癌，低分化鳞状细胞癌（SCC），淋巴结清扫数小于16个,肿瘤大小大于36mm是复发的高危因素.在具有复发高危因素的患者中，ACT导致DFS显著延长(HR，0.4689，95CI，1.193-3.818；p=0.0108）和OS（HR，0.4696，95CI，0.6578-6.895；p=0.2073），尽管OS未能达到统计学意义。在倾向得分匹配(PSM)之后，两组中有67对患者为1：1匹配，所有基线特征均平衡。结果还表明，ACT与改善的DFS(HR，0.4776，95CI，0.9779-4.484；p=0.0440），而OS没有显着差异（92.5％与91.0%；HR，0.6167，95CI，0.1688-2.038；p=0.7458）。在低风险因素复发的患者中，DFS(HR,0.4831，95CI，0.03025-7.715；p=0.6068）和OS（HR，0.969，95CI，0.08364-11.21；p=0.9794）在接受ACT的人和未接受ACT的人之间没有显着差异。
结论：在完全切除的IB期NSCLC患者中，ACT可以提高复发风险高的患者的生存率。需要进一步的大型多中心研究来证实这些发现。
