背景:非小细胞肺癌(NSCLC)合并意外胸膜播散(UPD)的患者是否可以从肿瘤切除中获得生存益处仍存在争议。
方法:完全,纳入2012年至2016年的169例UPDNSCLC患者。将患者分为肿瘤切除组和开闭组。用对数秩检验比较无进展生存期(PFS)和总生存期(OS)。多变量Cox分析用于确定预后因素。
结果:65例患者接受了开放闭合手术,104例患者接受了主要肿瘤和可见的胸膜结节切除术。肿瘤切除显著延长OS(风险比[HR]:0.408,P<0.001),局部PFS(HR:0.283,P<0.001),区域PFS(HR:0.506,P=0.005),远处转移(HR:0.595,P=0.032)。多变量Cox分析证实手术方式是OS的独立预后因素,本地PFS和区域PFS,除了远处转移。亚组分析显示肿瘤切除不能改善靶向治疗患者的OS(HR:0.649,P=0.382)。然而,肿瘤切除对单独接受辅助化疗的患者有益(HR:0.322,P<0.001).在肿瘤切除组中,肺叶切除术(HR:0.960,P=0.917)和系统性淋巴结清扫术(HR:1.512,P=0.259)未显示OS的生存获益.
结论:对于不能接受辅助靶向治疗的UPD患者,主要肿瘤和可见胸膜结节切除术可以改善预后。不进行系统性淋巴结清扫术的肺叶下切除术可能是最佳方法。
BACKGROUND: Whether patients with non-small cell lung cancer (NSCLC) with unexpected pleural dissemination (UPD) could get survival benefit from tumor resection remained controversial.
METHODS: Totally, 169 patients with NSCLC with UPD were included between 2012 and 2016. Patients were divided into the tumor resection and open-close group. Progression-free survival (PFS) and overall survival (OS) were compared with a log-rank test. The multivariable Cox analysis was applied to identify prognostic factors.
RESULTS: Sixty-five patients received open-close surgery and 104 patients underwent main tumor and visible pleural nodule resection. Tumor resection significantly prolonged OS (hazard ratio [HR]: 0.408, P < 0.001), local PFS (HR: 0.283, P < 0.001), regional PFS (HR: 0.506, P = 0.005), and distant metastasis (HR: 0.595, P = 0.032). Multivariable Cox analysis confirmed that surgical method was an independent prognostic factor for OS, local PFS and regional PFS, except distant metastasis. Subgroup analyses indicated that tumor resection could not improve OS in the patients who received targeted therapy (HR: 0.649, P = 0.382), however, tumor resection was beneficial for the patients who received adjuvant chemotherapy alone (HR: 0.322, P < 0.001). In the tumor resection group, lobectomy (HR: 0.960, P = 0.917) and systematic lymphadenectomy (HR: 1.512, P = 0.259) did not show survival benefit for OS.
CONCLUSIONS: Main tumor and visible pleural nodule resection could improve prognosis in patients with UPD who could not receive adjuvant targeted therapy. Sublobar resection without systematic lymphadenectomy may be the optimal procedure.