ⅢA(N_2)期非小细胞肺癌术后不良预后影响因素及术后辅助治疗的研究进展
摘要
ⅢA(N_2)期非小细胞肺癌(NSCLC)的异质性较强,生存差异明显,单纯手术治疗的预后不理想。多项回顾性研究显示,N_2淋巴结转移状态、T分期、肿瘤大小、N_2包膜的完整性等为ⅢA(N_2)期NSCLC术后患者预后的影响因素,因此为了预防ⅢA(N_2)期NSCLC患者术后出现局部复发和远处转移,延长患者的生存期,术后辅助治疗成为国内外研究的焦点。术后辅助化疗可以使ⅢA(N_2)期NSCLC患者明显获益,已成为术后辅助治疗的主要手段;但对于ⅢA(N_2)期NSCLC患者术后是否联合放疗、靶向治疗等尚存在争议,因此需要更多高级别的前瞻性多中心临床试验支持。
引文
[1]张琴,傅小龙,蔡旭伟,等.手术完全切除的ⅡA(N2)期非小细胞肺癌失败表型分析[J].中国癌症杂志,2017,27(5):383-388.
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[22]Sun JM,Noh JM,Oh D,et al.Randomized phase II trial comparing chemoradiotherapy with chemotherapy for completely resected unsuspected N2-positive non-small cell lung cancer[J].J Thorac Oncol,2017,12(12):1806-1813.
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[25]吴一龙,孙燕,王长利,等.靶向治疗:新问题、新探索[J].循证医学,2015,15(4):193-197.
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[27]Masters GA,Temin S,Azzoli CG,et al.Systemic therapy for stage IV non-small-cell lung cancer:american society of clinical oncology clinical practice guideline update[J].JClin Oncol,2015,33(30):3488-3515.
[28]Reck M,Popat S,Reinmuth N,et al.Metastatic non-smallcell lung cancer(NSCLC):ESMO clinical practice guidelines for diagnosis,treatment and follow-up[J].Ann Oncol,2014,25(Suppl 3):27-39.
[29]Wakelee HA,Dahlberg SE,Keller SM,et al.Adjuvant chemotherapy with or without bevacizumab in patients with resected non-small-cell lung cancer(E1505):an open-label,multicentre,randomised,phase 3 trial[J].Lancet Oncol,2017,18(12):1610-1623.
[30]Chen Z,Luo Q,Zhou Z,et al.Endostar in combination with postoperative adjuvant chemotherapy prolongs the disease free survival of stage IIIA NSCLC patients with high VEGF expression[J].Oncotarget,2017,8(45):79703-79711.
[2]岳金波,王真真,于金明.ⅡA期非小细胞肺癌术后治疗研究现状[J].中华肿瘤防治杂志,2013,20(20):1614-1618.
[3]Berghmans T,Paesmans M,Sculier JP.Prognostic factors in stage III non-small cell lung cancer:a review of conventional,metabolic and new biological variables[J].Ther Adv Med Oncol,2011,3(3):127-138.
[4]斯琴高娃,李墨.非小细胞肺癌调强放化疗的近期疗效观察[J].中华肿瘤防治杂志,2012,19(8):619-621.
[5]Bonomi M,Pilotto S,Milella M,et al.Adjuvant chemotherapy for resected non-small-cell lung cancer:future perspectives for clinical research[J].J Exp Clin Cancer Res,2011,30:115.
[6]Robinson LA,Ruckdeschel JC,Wagner H Jr,et al.Treatment of nonsmall cell lung cancer-stage IIIA:ACCP evidence-based clinical practice guidelines(2nd edition)[J].Chest,2007,132(3 Suppl):243S-265S.
[7]杨合利,戴亮,李培,等.121例手术切除的N2-Ⅱa期非小细胞肺癌患者的生存分析[J].中国肺癌杂志,2015,18(8):505-511.
[8]侯智亮.ⅢA(N2)期非小细胞肺癌术后预后因素分析[J].医药论坛杂志,2017,38(4):95-96.
[9]杨锫,师颖瑞,杨敬儒.ⅡA期N2非小细胞肺癌术后放疗疗效及预后因素分析[J].临床肺科杂志,2013,18(6):1100-1102.
[10]Veeramachaneni NK,Feins RH,Stephenson BJ,et al.Management of stage IIIA non-small cell lung cancer by thoracic surgeons in North America[J].Ann Thorac Surg,2012,94(3):922-926.
[11]Arriagada R,Bergman B,Dunant A,et al.Cisplatin-based adjuvant chemotherapy in patients with completely resected non-small-cell lung cancer[J].N Engl J Med,2004,350(4):351-360.
[12]Douillard JY,Rosell R,De Lena M,et al.Adjuvant vinorelbine plus cisplatin versus observation in patients with completely resected stage IB-IIIA non-small-cell lung cancer(Adjuvant Navelbine International Trialist Association[ANITA]):a randomised controlled trial[J].Lancet Oncol,2006,7(9):719-727.
[13]孙海波,王思愚,区伟,等.ⅡA-N2期非小细胞肺癌术后辅助化疗的前瞻性研究[J].中国肺癌杂志,2009,12(9):975-982.
[14]Matsuguma H,Nakahara R,Ishikawa Y,et al.Postoperative radiotherapy for patients with completely resected pathological stage IIIA-N2non-small cell lung cancer:focusing on an effect of the number of mediastinal lymph node stations involved[J].Interact Cardiovasc Thorac Surg,2008,7(4):573-577.
[15]PORT Meta-analysis Trialists Group.Postoperative radiotherapy in non-small-cell iung cancer:systematematic review and meta-analysis of individual patient data from nine randomised controlled trials[J].Lancet,1998,352(9124):257-263.
[16]Lally BE,Zelterman D,Colasanto JM,et al.Postoperative radiotherapy for stage II or III non-small-cell lung cancer using the surveillance,epidemiology,and end results database[J].J Clin Oncol,2016,24(19):2998-3006.
[17]Corso CD,Rutter CE,Wilson LD,et al.Re-evaluation of the role of postoperative radiotherapy and the impact of radiation dose for non-small-cell lung cancer using the National Cancer Database[J].J Thorac Oncol,2015,10(1):148-155.
[18]Kim BH,Kim HJ,Wu HG,et al.Role of postoperative radiotherapy after curative resection and adjuvant chemotherapy for patients with pathological stage N2non-smallcell lung cancer:a propensity score matching analysis[J].Clin Lung Cancer,2014,15(5):356-364.
[19]刘翼,阿迪力,陆艳荣,等.ⅢA(N2)期非小细胞肺癌术后放疗疗效分析[J].中国癌症杂志,2013,23(6):452-456.
[20]Lei T,Xu XL,Chen W,et al.Adjuvant chemotherapy plus radiotherapy is superior to chemotherapy following surgical treatment of stageⅡA N2non-small-cell lung cancer[J].Oncol Targets Ther,2016,9:921-928.
[21]李继泉,崔李平.Ⅲ期非小细胞肺癌患者肺癌根治术后同步放化疗效果观察[J].山东医药,2015,55(42):56-58.
[22]Sun JM,Noh JM,Oh D,et al.Randomized phase II trial comparing chemoradiotherapy with chemotherapy for completely resected unsuspected N2-positive non-small cell lung cancer[J].J Thorac Oncol,2017,12(12):1806-1813.
[23]Kelly K,Altorki NK,Eberhardt WE,et al.Adjuvant erlotinib versus placebo in patients with stage IB-IIIA nonsmall-cell lung cancer(RADIANT):a randomized,doubleblind,phase III trial[J].J Clin Oncol,2015,33(34):4007-4014.
[24]Zhong WZ,Wang Q,Mao WM,et al.Gefitinib versus vinorelbine plus cisplatin as adjuvant treatment for stage II-IIIA(N1-N2)EGFR-mutant NSCLC(ADJUVANT/CTONG1104):a randomised,open-label,phase 3 study[J].Lancet Oncol,2017,19(1):139.
[25]吴一龙,孙燕,王长利,等.靶向治疗:新问题、新探索[J].循证医学,2015,15(4):193-197.
[26]NCCN guidelines panel members.The NCCN guidelines for nonsmall cell lung cancer(version 4.2016)[EB/OL]..Fort Washington,PA:National Comprehensive Cancer Network,2016:NSCLC-19[2016-01-12].https://www.nccn.org/professionals/physician_gls/pdf/nscl.pdf.
[27]Masters GA,Temin S,Azzoli CG,et al.Systemic therapy for stage IV non-small-cell lung cancer:american society of clinical oncology clinical practice guideline update[J].JClin Oncol,2015,33(30):3488-3515.
[28]Reck M,Popat S,Reinmuth N,et al.Metastatic non-smallcell lung cancer(NSCLC):ESMO clinical practice guidelines for diagnosis,treatment and follow-up[J].Ann Oncol,2014,25(Suppl 3):27-39.
[29]Wakelee HA,Dahlberg SE,Keller SM,et al.Adjuvant chemotherapy with or without bevacizumab in patients with resected non-small-cell lung cancer(E1505):an open-label,multicentre,randomised,phase 3 trial[J].Lancet Oncol,2017,18(12):1610-1623.
[30]Chen Z,Luo Q,Zhou Z,et al.Endostar in combination with postoperative adjuvant chemotherapy prolongs the disease free survival of stage IIIA NSCLC patients with high VEGF expression[J].Oncotarget,2017,8(45):79703-79711.