Classic reappearance: After T2N0M0 (7th edition) patients receive adjuvant chemotherapy, the 5-year OS rate has a significant benefit

*Only for medical professionals to read for reference.
Adjuvant chemotherapy for NSCLC patients can significantly improve the 5-year OS of patients with a tumor size of 3.
1-7cm.

Research background For patients with operable non-small cell lung cancer (NSCLC), radical surgical resection is the preferred treatment [1], but the 5-year overall survival (OS) rate of patients is still not ideal, and the 5-year OS rate of patients with pathological stage IA It is 73%, while the 5-year OS rate of pathological stage IIIA patients is only 24% [2].

 Several previous studies have suggested [3-5] that postoperative adjuvant chemotherapy can improve the OS rate of patients with stage II-III NSCLC, but there are also studies that suggest that the survival benefit of adjuvant chemotherapy may be limited to stage II or IIIA patients The survival benefit of patients with stage IB is not significant, and for patients with stage IA, there is even a phenomenon of reduced survival benefit.

 However, a systematic review and meta-analysis study called Cochrane found that this may not be the case [6].
Among patients with stage IB NSCLC who received platinum-containing dual-agent adjuvant chemotherapy, the 5-year OS rate increased from 55% to 60%.
, Similar to the benefits of patients in stage II (from 40% to 45%) and stage III (from 30% to 35%), the absolute value is increased by 5%.

To this end, researchers such as Daniel Morgensztern MD conducted another retrospective study to evaluate T2N0M0 (according to the 7th edition of AJCC lung cancer TNM staging, T2N0M0 is IB-IIA stage) after complete surgical resection (R0 resection) The efficacy of adjuvant chemotherapy.

 The results of the study were published in the Journal of Thoracic Oncology in 2016 (IF=13.
357).
The data of this study came from the National Cancer Database (NCDB), which was jointly collected by the Cancer Committee of the American College of Surgeons and the American Cancer Society.This study has very important guiding significance for early NSCLC patients whether to undergo adjuvant chemotherapy, and provides new ideas and new strategies for prolonging the 5-year OS of NSCLC patients.

Research methods This study screened out NSCLC patients with pathological stage T2N0M0 from the NCDB from 2004 to 2011.
After R0 resection, they were divided into two categories: ①Patients who received adjuvant chemotherapy; ②Patients who did not receive adjuvant chemotherapy (observation group) , And divided into 4 groups according to the tumor size: 3.
1-3.
9 cm (S3), 4-4.
9 cm (S4), 5-5.
9 cm (S5) and 6-7 cm (S6-7).

Patients who died within 1 month after surgery were excluded, and only patients who received adjuvant chemotherapy within 120 days after surgical resection were included.

 Adjuvant chemotherapy can significantly improve the OS of patients with a tumor size of 3.
1-7cm.
Among the 25,267 patients included in the analysis, 4,996 (19.
7%) patients received adjuvant chemotherapy, and 20,271 (81.
3%) patients in the observation group.

Compared with the observation group, the patients who received adjuvant chemotherapy were younger (p<0.
001) and the tumor diameter was larger (p<0.
001), and the number of patients receiving lower lobectomy was less than the observation group (6.
1% vs 8.
6%, p<0.
001) ).

 1.
Univariate analysis: regardless of size (3.
1-7cm), patients can benefit from adjuvant chemotherapy.
In univariate analysis, the 5-year OS rate of the observation group is inversely proportional to the tumor size, and the 5-year OS rate ranges from The 55% of the S3 group dropped to 44% of the S6-7 group.

In patients receiving adjuvant chemotherapy, the 5-year OS rate ranges from 64% in the S6-7 group to 67% in the S3 group (Figure 1 and Table 1), which means: the size is 3.
1-3.
9 cm (S3) After receiving adjuvant chemotherapy, there was no significant difference in the 5-year OS rate for tumors of, 4-4.
9 cm (S4), 5-5.
9 cm (S5), and 6-7 cm (S6-7).  Figure 1 Kaplan-Meier survival curve analysis based on tumor size and adjuvant chemotherapy: (A) tumor size is 3.
1 to 3.
9 cm, (B) tumor size is 4 to 4.
9 cm, (C) tumor size is 5 to 5.
9 cm, and (D) tumor Size 6 to 7cm.

 Table 1 Univariate analysis of overall survival (comparison between adjuvant chemotherapy group and observation group) 2.
Multivariate analysis: The 5-year OS rate of S3, S4, S5, and S6-7 groups is 8%, 11%, and 11%, respectively.
9% and 16% In a multivariate analysis, adjuvant chemotherapy is associated with increased survival of all tumor size groups, which means that adjuvant chemotherapy can significantly improve the median OS and 5-year OS rate of different tumor size groups, S3, S4, S5 The absolute benefits of the S6-7 and S6-7 groups were 8%, 11%, 9%, and 16%, respectively (Table 2).

Among them, among S3 patients, the median OS and 5-year OS rates in the observation group were 78.
9 months and 60%, while those in the adjuvant chemotherapy group were 101.
6 months and 68% (Figure 2).

 Table 2 According to tumor size, chemotherapy and observational propensity scores were matched.
Figure 2 OS Kaplan-Meier survival curve analysis of patients in S3 group according to whether they received adjuvant chemotherapy.
The researchers proposed that, as expected, the results of the study showed that the observation group had 5 The annual OS rate varies significantly according to the size of the patient’s tumor.
However, the 5-year OS rate of patients receiving adjuvant chemotherapy is very similar, which suggests that adjuvant chemotherapy has survival benefits in patients with different tumor sizes, and in patients with tumors with larger diameters.
The benefit is greater.

 There are still some limitations in the data of this study.

First of all, there is limited information about the reasons why patients choose or not choose adjuvant chemotherapy.
In addition, there are no relevant data on the staging standards before surgical resection, the chemotherapy regimen used, and the surgical mortality rate.

However, the data of the study shows that regardless of the tumor size, patients with NSCLC who are completely resected at stage T2N0M0 can benefit from adjuvant chemotherapy, thereby improving the patient's long-term OS.

  Translation and proofreading expert, Professor Xing Wenqun, Director of Thoracic Surgery, Henan Cancer Hospital, Member of the Standing Committee of the Mediastinum Special Committee of the Chinese Anti-Cancer Association Member of the Nutrition Pathology Group of the Chinese Anti-Cancer Association Cancer Nutrition Special Committee, Deputy Chairman of the Esophageal Cancer Special Committee of Henan Anti-Cancer Association Henan Province Vice Chairman of the Lung Cancer Specialty Committee of the Provincial Anti-Cancer Association, Vice Chairman of the Mediastinal Tumor Professional Committee of the Henan Anti-Cancer Association, Member of the Standing Committee of the Thoracic Surgery Branch of the Henan Medical Association, Professor Shang Changhai, Member of the Editorial Board of the Journal of Esophageal Diseases, Director of the Henan Anti-Cancer Association, China Anticancer Association Tumor Hyperthermia Professional Committee Deputy Chairman of Henan Academic Branch Henan Provincial Medical Doctor Association Standing Committee Member of Henan Provincial Anticancer Association Esophageal Cancer Professional Committee Standing Committee of Henan Anticancer Association Lung Cancer Professional Committee Standing Committee of Henan Anticancer Association Mediastinal Tumor Member of the Standing Committee of the Professional Committee Member of the Oncology Professional Committee of the Henan Medical Association Member of the Lung Cancer Minimally Invasive Group of the Henan Medical Association Member of the Colorectal Cancer Minimally Invasive Group of the Henan Medical Association Member of the Expert Group of the Henan Medical Insurance Bureau Deputy Director of the Oncology Professional Committee of the Xinyang Medical Association Member and Secretary-General Xinyang City Anti-Cancer Association Vice Chairman Xinyang City Medical Doctor Association Oncologist Branch Chairman Xinyang City Anti-Cancer Association Lung Cancer Professional Committee Chairman Xinyang City "May 1st Labor Medal" Winner Xinyang City "Model Worker" Xinyang City Chest The pioneer of microscopic esophageal cancer and lung cancer surgery, Xinyang Central Hospital's general director of oncology reference materials: [1] JA Howington, MG Blum, AC Chang, et al.
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