原标题：Neoadjuvant Chemotherapy-alone vs Chemoradiation followed by Sleeve Resection for Locally Advanced Non-Small Cell Lung Cancer

Introduction

Traditionally, neoadjuvant chemoradiation is followed by surgery in patients with locally advanced resectable non-small cell lung cancer (NSCLC). The risks and benefits of this approach are not well defined in patients requiring a sleeve lung resection. In this context, we compare the short- and long-term outcomes of neoadjuvant chemotherapy-alone versus chemoradiation followed by sleeve lung resection.

摘要

传统上，对于局部晚期可切除的非小细胞肺癌(NSCLC)患者，一般在新辅助放化疗后进行手术治疗。对于需要袖状肺切除术的患者，这种方法的风险和好处还没有明确定义。在此背景下，我们比较了单独新辅助化疗和同步放化疗后肺袖状切除术的短期和长期结果。

Methods

We used the National Cancer Database to identify locally advanced NSCLC patients who received either chemotherapy-alone or chemoradiation in the neoadjuvant setting followed by a sleeve lung resection between 2006 and 2017. Our outcomes of interest were 30-day mortality, 90 day mortality, and overall survival. To minimize confounding by indication, we used propensity score adjustment, logistic regression, Kaplan-Meier survival analysis, and Cox proportional hazards models to identify associations.

研究方法：

我们使用美国国家癌症数据库(National Cancer Database)，确定了2006年至2017年期间在新辅助治疗中接受单独化疗或放化疗后进行袖状肺切除术的局部晚期NSCLC患者。我们感兴趣的结果是30天死亡率，90天死亡率和总生存率。为了尽量减少因适应症造成的混淆，我们使用倾向评分调整、logistic回归、Kaplan-Meier生存分析和Cox比例风险模型来识别相关性。

Results

Of 176 total patients, 92 (54.9%) received neoadjuvant chemotherapy-alone and 84 (45.1%) received neoadjuvant chemoradiation. Patients in both groups were well balanced in terms of age, sex, race, Charlson-Deyo comorbidity index, insurance status, median income, and education (all p>0.05). Similarly, the groups were well balanced in terms of tumor histology, and stage (all p>0.05).

Patients receiving neoadjuvant chemoradiation had similar 30-day mortality (0% vs 2.2%; p=0.179), but higher 90-day mortality (11.96% vs 2.38%, P=0.015), and there was no difference in overall survival between patients receiving neoadjuvant chemoradiation compared to chemotherapy-alone (Figure; p=0.621). On multivariable analysis, neoadjuvant chemoradiation was associated with higher 90 day mortality (aOR=6.2; p<0.027) and not associated with overall survival (aHR=1.1 p=0.729).

结果：

在176例患者中，92例(54.9%)接受了新辅助化疗，84例(45.1%)接受了新辅助放化疗。两组患者在年龄、性别、种族、charson - deyo共病指数、保险状况、中位收入和教育程度方面均达到良好平衡(均p>0.05)。同样，两组在肿瘤组织学和分期方面也很平衡(均p>0.05)。接受新辅助放化疗的患者30天死亡率相似(0% vs 2.2%;p=0.179)，但90天死亡率更高(11.96% vs 2.38%， p= 0.015)，接受新辅助放化疗的患者与单独化疗的患者的总生存期无差异(图;p = 0.621)。多变量分析显示，新辅助放化疗与较高的90天死亡率相关(aOR=6.2;p<0.027)，且与总生存率无关(aHR=1.1, p=0.729)。

Conclusion

In this first national study of patients with locally advanced resectable NSCLC requiring a sleeve lung resection, neoadjuvant chemoradiation was associated with a 5-fold increase in 90-day mortality without an overall survival benefit over neoadjuvant chemotherapy-alone.

结论：

在这项首次针对需要袖状肺切除术的局部晚期可切除NSCLC患者的全国性研究中，新辅助放化疗与单纯新辅助化疗相比，90天死亡率增加5倍，但总体生存期没有增加。