原標題：Survival of Patients with Persistent N1 or N2 Disease After Induction Therapy for Stage IIIA-N2 Non-Small-Cell Lung Cancer

Introduction

The role of surgery for patients with stage IIIA-N2 non-small-cell lung cancer (NSCLC) who have persistent nodal disease after induction chemotherapy or induction chemoradiation is unclear. The objective of this study is to evaluate the long-term survival of patients with Stage IIIA-N2 NSCLC who undergo surgery for persistent N1 or N2 disease following induction therapy.

摘要：

對於IIIA-N2期非小細胞肺癌(NSCLC)患者，在誘導化療或誘導放化療後有持續性結節病，手術的作用尚不清楚。本研究的目的是評估IIIA-N2期NSCLC患者在誘導治療後因持續性N1或N2疾病接受手術的長期生存率。

Methods

Overall survival of patients with clinical T1-3 N2 M0 who underwent lobectomy after induction chemotherapy or induction chemoradiation and had pathologic N1 (pN1) or N2 (pN2). NSCLC in the National Cancer Data Base from 2004 to 2017 was evaluated using Kaplan-Meier analysis.

研究方法：

誘導化療或誘導放化療後行肺葉切除術，且有病理性N1 (pN1)或N2 (pN2)疾病的臨床T1-3 - N2 M0患者的總生存期。使用Kaplan-Meier生存分析法對2004 - 2017年國家癌症數據庫中的NSCLC進行評估。

Results

From 2004-2017, there were 2,230 patients that underwent lobectomy following induction therapy for cT1-3N2M0 NSCLC who were then found to have pN1 or pN2 disease.

Of these patients, 1,085 (49%) received induction chemotherapy and 1,145 (51%) received induction chemoradiation. In the induction chemotherapy group, the two-year survival was 72% ([95% CI: 65%-77%]) for patients with pN1 disease and 73% ([95% CI: 70%-76%]) for patients with pN2 disease. The five-year survival was 47% ([95% CI: 39%-55%]) for pN1 disease and 45% ([95% CI: 42%-49%]) for pN2 disease. In the induction chemoradiation group, the two-year survival was 72% ([95% CI: 66%-77%]) for pN1 disease and 72% ([95% CI: 70%-75%]) for pN2 disease. The five-year survival was 48% ([95% CI: 41%-55%]) for pN1 disease and 46% ([95% CI: 42%-50%]) for pN2 disease.

結果：

從2004年至2017年，共有2230例cT1-3N2M0非小細胞肺癌患者，在誘導治療後接受肺葉切除術，隨後發現有pN1或pN2疾病。在這些患者中，1,085例(49%)接受了誘導化療，1,145例(51%)接受了誘導放化療。

在誘導化療組中，pN1疾病患者的2年生存率為72% (95% CI: 65%-77%)，pN2疾病患者的2年生存率為73% (95% CI: 70%-76%)。pN1疾病的五年生存率為47% ([95% CI: 39%-55%])， pN2疾病的五年生存率為45% ([95% CI: 42%-49%])。

在誘導放化療組，pN1疾病的2年生存率為72% (95% CI: 66%-77%)，pN2疾病的2年生存率為72% (95% CI: 70%-75%)。pN1疾病的五年生存率為48% ([95% CI: 41%-55%])， pN2疾病的五年生存率為46% ([95% CI: 42%-50%])。

Conclusion

In this national study, the five-year survival of patients with cT1-3N2M0 NSCLC that underwent lobectomy following induction chemotherapy or chemoradiation and were then found to have persistent pN1 and pN2 disease was approximately 46-48%. These findings suggest that invasive mediastinal restaging after induction therapy for stage IIIA N2 NSCLC may not be necessary. These findings also suggest that persistent N1 and N2 disease after induction chemotherapy or induction chemoradiation for stage IIIA-N2 NSCLC should not be considered a contraindication to surgical intervention.

結論：

在這項全國性研究中，cT1-3N2M0非小細胞肺癌患者，在誘導化療或放化療後接受肺葉切除術，隨後發現有持續性pN1和pN2疾病的5年生存率約為46-48%。這些發現表明，IIIA期N2 NSCLC誘導治療後可能沒有必要進行侵襲性縱隔重建術。這些發現也表明，IIIA-N2期NSCLC誘導化療或誘導放化療後持續的N1和N2疾病不應被認為是手術幹預的禁忌症。