2015年6月3日訊/生物谷BIOON/-根據在2015年6月出版在《胸外科年報》的一篇文章稱，診斷為遷移性非小細胞肺癌(NSCLC)病人可能會因手術切除(肺全部或部分切除)以及化療和放射治療的聯合療法而延長生命。
「目前，大多數處於 IIIB 階段的非小細胞肺癌患者不適合手術，他們只能接受化療和放療。」 Matthew J. Bott博士說。
在非小細胞肺癌的IIIB 階段，腫瘤通常已經擴散到淋巴結或入侵到肺周圍的其他組織器官，如心臟、食道、氣管等器官組織。處於非小細胞肺癌IIIB 階段病人的5年總體生存率只有10%。
Bott博士及其同事根據美國國家癌症資料庫評估了9173名非小細胞肺癌IIIB 階段病人，這些病人在1998年和2010年之間接受過聯合治療(多模式綜合性療法)。
這些患者被分成兩組：第一組接受過化療和放療(CR組)相結合使用的7459名患者；第二組是接受化療、輻射和手術(CRS組)相結合使用的1714名患者。
研究人員發現，CRS組總生存期中位數比CR組要多9個多月時間(分別為25.9個月和16.3個月)。
CRS組病人多為年輕的白種人，他們所患的腫瘤比CR組要小，Bott博士警告說，手術應該添加到經過千挑萬選的患者的治療方案中，而且需要進行更多的研究才能做出明確的指導方針。
「我們希望我們的研究重新討論關於這些患者的最佳治療方案，創造更大的多學科治療方案評價，增加肺胸外科醫生參與決策的過程。」Bott博士說。（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.