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首页 » 癌症研究 » The Annals of Thoracic Surgery:转移性肺癌的多模式治疗可提高患者生存率

The Annals of Thoracic Surgery:转移性肺癌的多模式治疗可提高患者生存率

来源:生物谷 2015-06-03 14:50

2015年6月3日讯/生物谷BIOON/-根据在2015年6月出版在《胸外科年报》的一篇文章称,诊断为迁移性非小细胞肺癌(NSCLC)病人可能会因手术切除(肺全部或部分切除)以及化疗和放射治疗的联合疗法而延长生命。

“目前,大多数处于 IIIB 阶段的非小细胞肺癌患者不适合手术,他们只能接受化疗和放疗。” Matthew J. Bott博士说。

在非小细胞肺癌的IIIB 阶段,肿瘤通常已经扩散到淋巴结或入侵到肺周围的其他组织器官,如心脏、食道、气管等器官组织。处于非小细胞肺癌IIIB 阶段病人的5年总体生存率只有10%。

Bott博士及其同事根据美国国家癌症数据库评估了9173名非小细胞肺癌IIIB 阶段病人,这些病人在1998年和2010年之间接受过联合治疗(多模式综合性疗法)。

这些患者被分成两组:第一组接受过化疗和放疗(CR组)相结合使用的7459名患者;第二组是接受化疗、辐射和手术(CRS组)相结合使用的1714名患者。

研究人员发现,CRS组总生存期中位数比CR组要多9个多月时间(分别为25.9个月和16.3个月)。

CRS组病人多为年轻的白种人,他们所患的肿瘤比CR组要小,Bott博士警告说,手术应该添加到经过千挑万选的患者的治疗方案中,而且需要进行更多的研究才能做出明确的指导方针。

“我们希望我们的研究重新讨论关于这些患者的最佳治疗方案,创造更大的多学科治疗方案评价,增加肺胸外科医生参与决策的过程。”Bott博士说。(生物谷Bioon.com)

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Multimodality treatment for metastatic lung cancer that includes surgery may improve survival rates

1.Varun Puri, MD et al.

Background The role of multimodality therapy in stage IIIB non–small cell lung cancer (NSCLC) remains inadequately studied. Although chemoradiation is currently the mainstay of treatment, randomized trials evaluating surgical intervention are lacking, and resection is offered selectively. Methods Data from patients with clinical stage IIIB NSCLC (T4N2 or any N3) undergoing definitive multimodality therapy were obtained from the National Cancer Database (NCDB). Multivariable Cox regression models were fitted to evaluate variables influencing overall survival (OS). Results From 1998 to 2010, 7,459 patients with clinical stage IIIB NSCLC were treated with definitive chemoradiation (CR group), whereas 1,714 patients underwent chemotherapy, radiation, and surgical intervention in any sequence (CRS group). CRS patients were more likely to be younger and white and have slightly smaller tumors (all p < 0.01). There was no difference in Charlson Comorbidity Index (CCI) between the groups (p = 0.5). In the CRS group, 79% of patients received neoadjuvant therapy. Thirty-day surgical mortality was 3%. Factors associated with improved OS in multivariate analysis included younger age, female sex, decreased CCI, smaller tumor size, and surgical resection (hazard ratio [HR], 0.57; 95% confidence interval [CI], 0.52–0.63). Among patients treated with surgical intervention, incomplete resection was associated with decreased OS (HR, 1.52; 95% CI, 1.20–1.92). Median OS was longer in the CRS group (25.9 months versus 16.3 months; p < 0.001). Propensity matched analysis on 631 patient pairs treated with CRS versus CR confirmed these findings (median OS, 28.9 versus 17.2 months; p < 0.001). Conclusions Surgical resection as a part of multimodality therapy may be associated with improved OS in highly selected patients with stage IIIB NSCLC. Multidisciplinary evaluation of these patients is critical.

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