原标题： 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：

对于IIIA-N2期非小细胞肺癌(NSCLC)患者，在诱导化疗或诱导放化疗后有持续性结节病，手术的作用尚不清楚。本研究的目的是评估IIIA-N2期NSCLC患者在诱导治疗后因持续性N1或N2疾病接受手术的长期生存率。

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：

诱导化疗或诱导放化疗后行肺叶切除术，且有病理性N1 (pN1)或N2 (pN2)疾病的临床T1-3 - N2 M0患者的总生存期。使用Kaplan-Meier生存分析法对2004 - 2017年国家癌症数据库中的NSCLC进行评估。

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.

结果：

从2004年至2017年，共有2230例cT1-3N2M0非小细胞肺癌患者，在诱导治疗后接受肺叶切除术，随后发现有pN1或pN2疾病。在这些患者中，1,085例(49%)接受了诱导化疗，1,145例(51%)接受了诱导放化疗。

在诱导化疗组中，pN1疾病患者的2年生存率为72% (95% CI: 65%-77%)，pN2疾病患者的2年生存率为73% (95% CI: 70%-76%)。pN1疾病的五年生存率为47% ([95% CI: 39%-55%])， pN2疾病的五年生存率为45% ([95% CI: 42%-49%])。

在诱导放化疗组，pN1疾病的2年生存率为72% (95% CI: 66%-77%)，pN2疾病的2年生存率为72% (95% CI: 70%-75%)。pN1疾病的五年生存率为48% ([95% CI: 41%-55%])， pN2疾病的五年生存率为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.

结论：

在这项全国性研究中，cT1-3N2M0非小细胞肺癌患者，在诱导化疗或放化疗后接受肺叶切除术，随后发现有持续性pN1和pN2疾病的5年生存率约为46-48%。这些发现表明，IIIA期N2 NSCLC诱导治疗后可能没有必要进行侵袭性纵隔重建术。这些发现也表明，IIIA-N2期NSCLC诱导化疗或诱导放化疗后持续的N1和N2疾病不应被认为是手术干预的禁忌症。