Introduction

No evidence exists for postoperative adjuvant therapy in elderly or renal dysfunction patients with non-small-cell lung cancer (NSCLC) who are unfit to receive cisplatin (CDDP). Herein, we evaluated the efficacy of postoperative adjuvant therapy for CDDP-unfit patients.

Materials and methods

We defined CDDP-unfit patients as those aged ≥75 years or with renal dysfunction based on criteria established by expert panels and from prospective studies. CDDP-fit patients comprised all others. Between 2010 and 2020, among 1,423 patients with pathological stage II–III (8th edition of the AJCC-TNM Classification) NSCLC, 454 were identified as unfit for CDDP. Following propensity score matching in CDDP-unfit patients with and without postoperative adjuvant therapy, we analyzed the overall survival (OS) and disease-free survival (DFS) of each group and assessed the impact of adjuvant therapy on survival.

Results

OS was significantly better in patients who received adjuvant therapy than in those who did not (5-year OS rate: 76.1 % vs. 50.0 %, p < 0.01) among 255 propensity score-matched patients. DFS was also significantly better in patients who received adjuvant therapy than in those who did not (5-year OS: 54.6 % vs. 35.1 %, p < 0.01).

Conclusions

Our findings suggest that postoperative adjuvant therapy could be beneficial for CDDP-unfit patients aged ≥75 years or with renal dysfunction. Future studies for CDDP-unfit patients should be designed based on the results of this study to determine the potential benefits of adjuvant therapy.

中文翻译：

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辅助治疗对不适合顺铂的非小细胞肺癌患者的预后影响：多中心分析

介绍

对于不适合接受顺铂（CDDP）的老年或肾功能不全的非小细胞肺癌（NSCLC）患者，尚无证据表明术后辅助治疗。在此，我们评估了不适合 CDDP 的患者术后辅助治疗的效果。

材料和方法

我们根据专家小组和前瞻性研究制定的标准，将不适合 CDDP 的患者定义为年龄≥75 岁或肾功能障碍的患者。适合 CDDP 的患者包括所有其他患者。2010 年至 2020 年间，在 1,423 名病理学 II-III 期（AJCC-TNM 分类第 8 版）NSCLC 患者中，454 名被确定不适合 CDDP。对不适合 CDDP 的患者进行和未进行术后辅助治疗的倾向评分匹配后，我们分析了每组的总生存期 (OS) 和无病生存期 (DFS)，并评估了辅助治疗对生存的影响。

结果

 在 255 名倾向评分匹配的患者中，接受辅助治疗的患者的 OS 明显优于未接受辅助治疗的患者（5 年 OS 率：76.1 % vs. 50.0 %，p < 0.01）。接受辅助治疗的患者的 DFS 也显着优于未接受辅助治疗的患者（5 年 OS：54.6 % vs. 35.1 %，p  < 0.01）。

结论

我们的研究结果表明，术后辅助治疗可能对年龄≥75岁或肾功能不全的不适合CDDP的患者有益。未来针对不适合 CDDP 的患者的研究应根据本研究的结果进行设计，以确定辅助治疗的潜在益处。