A retrospective analysis of the three countries found that: insufficient adjuvant therapy for patients with stage IB-IIIA NSCLC will affect the long-term survival benefits of patients

*For medical professionals to read only, refer to the adjuvant chemotherapy for early non-small cell lung cancer (NSCLC), which depends on the patient's performance status and age, but its use and the drugs and combination drugs used in routine clinical practice have not been fully documented .

For patients with completely resected stage IB-IIIA NSCLC, current adjuvant treatments have limited efficacy and greater toxicity [1,2].

Study Design The main purpose of this retrospective observational study is to analyze and quantify the treatment of patients with stage IB-IIIA NSCLC completely resected in French, German and British research centers, and to evaluate the disease recurrence and progression of the same patient [3].

By collecting case data from January 1, 2009 to December 31, 2011.

Patients with stage IB-IIIA NSCLC who were ≥18 years old and who were completely resected were enrolled.
The average follow-up time was 26 months.

A total of 39 research centers participated in this study (France, 14; Germany, 11; UK, 14).

A total of 868 patients' data were included, of which 831 (95.
7%) patients had enough data for analysis (251 in France, 287 in Germany, and 293 in the UK).

In total, 402 patients (48.
4%) received adjuvant system therapy (61.
8% in France, 51.
9% in Germany, and 33.
4% in the UK).

(Table 1) Table 1: According to the results of the study on the percentage of patients receiving adjuvant therapy by stage, 64.
2% of 258 patients in France, Germany and the United Kingdom received adjuvant system therapy, of which cisplatin/vinorelbine is the most commonly used in these three countries The adjuvant treatment plan.If we consider the data of three countries/regions, in any country/region, more than 4% of patients receiving adjuvant chemotherapy receive carboplatin/paclitaxel (8.
4% of patients receiving adjuvant chemotherapy in France ), carboplatin/pemetrexed (6.
0% of patients receiving adjuvant chemotherapy in Germany), cisplatin/pemetrexed (5.
2% and 4.
7% of patients receiving adjuvant chemotherapy in France and Germany, respectively), and cisplatin alone Platinum (5.
1% of patients receiving adjuvant chemotherapy in the UK).

Most of the patients who received the three most common adjuvant chemotherapy regimens completed the expected course of two drugs [cisplatin (62.
1%)/vinorelbine (66.
0%); carboplatin (64.
1%)/vinorelbine ( 59.
0%); Cisplatin (57.
9%)/Gemcitabine (57.
9%)].

The reasons why 429 (51.
6%) patients in three countries did not receive adjuvant system treatment included patient refusal to receive treatment (12.
6%), comorbidities (11.
9%), complications or delayed recovery from surgery (8.
4%), and poor results (7%).

During the follow-up period, 272 patients (33%) relapsed, with recurrence rates ranging from 26% (UK) to 43% (France).

86 patients (10% of the total number of patients; 32% of the relapsed patients) first recurrence was local or regional recurrence without distant metastasis; 186 patients (22% of the total number of patients; 68% of the relapsed patients) The first recurrence involved distant metastasis (60 cases were also accompanied by local or regional recurrence).

Of the 86 patients with local recurrence, 14 patients progressed to metastatic disease during follow-up, so a total of 200 patients had distant metastases.

The most common metastatic sites were the brain (82 cases; 41%), lungs (65 cases; 33%), bones (47 cases; 24%), and liver (26 cases; 13%).

During the follow-up time available for analysis, the median OS was not reached.

The estimated 25th percentile of OS is 31.
2 months (95%CI: 26.
8-36.
0 months).

204 patients (24%) reported death; however, since 3 patients did not report the date of death, the survival analysis included only 201 patients who died.

Table 2: The overall median disease-free survival (DFS) of patients with disease progression or death was 48.
0 months (95%CI 42.
3 months-NE): The median DFS in France was 38.
5 months (95%CI 27.
4-NE) ), the median DFS in Germany is 48.
0 months (95%CI 48.
0 months-NE), and the median DFS in the UK is unpredictable (95%CI 42.
3-NE).

Compared with patients with stage IIA, IIB, or IIIA disease, the first quartile of patients with stage IB has a significantly longer DFS.

Figure 1: Kaplan-Meier survival curve of disease-free survival rate Table 2: According to the disease stage, the patient survival outcome (calculated from the time after surgical resection) is in 86 patients with local or regional recurrence without metastasis, 43 cases (50%) ) Received systematic treatment.

Heterogeneity has been observed among patients in various countries, with 66%, 42%, and 32% of patients receiving systemic treatment in France, Germany, and the United Kingdom, respectively.

Of the 200 patients with distant metastatic disease, 97 (49%) received systemic therapy.

Among them, pemetrexed (41 cases) and carboplatin (40 cases) are the most commonly used systemic treatment options.

Study conclusions The study found that more than 40% of stage II patients and 28.
6% of stage IIIA patients did not receive adjuvant therapy.

Among patients with stage IB disease, the proportion of patients receiving adjuvant chemotherapy is relatively low (15.
1%).

In this observational study, less than half of patients with stage IB-IIIA NSCLC received adjuvant system therapy, but the first recurrence rate of distant metastatic disease was observed in patients who did not receive adjuvant therapy.

Therefore, the research emphasizes the need for more effective systemic adjuvant therapy for this population.

Translation and proofreading expert Professor Yang Jingchun, Director of Thoracic Surgery of Tongliao City Hospital and Chief Physician of Inner Mongolia Autonomous Region 321 talents.
He has been engaged in clinical work in thoracic surgery for nearly 30 years.
He is proficient in various types of thoracic surgery.
The first case of minimally invasive thoracoscopic surgery.
Member of the Thoracic Surgery Branch of the Chinese Medical Care International Exchange Promotion Association, Vice Chairman of the Thoracic Oncology Committee of the Inner Mongolia Medical Association, Vice Chairman of the Thoracic Surgery Branch of the Inner Mongolia Medical Association, Member of the Inner Mongolia Medical Association Thoracic Surgery Branch, Inner Mongolia Autonomous Region Medical Association Medical Malpractice Technical Appraisal Expert Database Member Zhang Liang Attending Physician Attending Cardiothoracic Surgery, Xing’an League People’s Hospital Cardiovascular Surgery Committee Standing Committee Reference Materials: [1]FSFarhat,W.
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