前瞻性分析Stage-III-N2非小细胞肺癌患者管理实践（OBSERVE IIIA-B GFPC 04-2020研究）

A prospective analysis of the management practices for patients with Stage-III-N2Non-Small-Cell lung cancer (OBSERVE IIIA-B GFPC 04-2020Study)

LUNG CANCER

影响因子:4.4

分区:医学2区 / 肿瘤学3区呼吸系统3区

发表日期:2024 Aug

作者: Mathilde Jacob, Pierre Fournel, Claire Tissot, Jacques Cadranel, Olivier Bylicki, Isabelle Monnet, Grégoire Justeau, Charles Ricordel, Pascal Thomas, Lionel Falchero, Chrystel Locher, Marie Wislez, Alain Vergnenegre, Samir Abdiche, Floran Guisier, Acya Bizieux, Regine Lamy, Geraldine François, Gonzagues De Chabot, Thomas Pierret, Marie Sabatini, Marion Abeillera, Sabine Vieillot, Stephanie Martinez, Hugues Morel, Hélène Doubre, Anne Madroszyk, Margaux Geier, Jean LucLabourey, Christos Chouaïd, Laurent Greillier

DOI: 10.1016/j.lungcan.2024.107868

摘要

基于多模态策略（手术或放疗结合系统性药物）对III期-N2非小细胞肺癌（NSCLC）患者的管理仍存在争议。患者以治愈为目的进行治疗，现有数据显示完全切除后生存期延长。然而，尚无关于"肿瘤可切除性"的统一定义。本研究旨在分析法国肿瘤委员会（TBM）对III期-N2 NSCLC治疗决策的一致性。选取在圣艾蒂安大学医院胸科TBM讨论的六例III期-N2 NSCLC患者，匿名报告并提交参与的TBMs。本多中心、前瞻性、观察性研究的主要目标是评估每个病例的TBM决策一致性。次要终点是识别可能影响决策的患者人口学或技术因素。本研究共涉及来自大学医院、癌症中心、综合医院及私立医院的27个TBM。六例病例的决策未出现一致意见。三例病例的决策较为一致（分别有78%、85%、88%的TBM选择药物治疗），而其余三例则较为矛盾（在药物与手术策略中，分别有44%/56%、46%/54%、58%/42%的TBM偏向）。有趣的是，关于化疗放疗和术前化疗的决策在药物和手术策略中也存在分歧。医院类型、专家参与程度及医院活动量与治疗决策无显著相关性。结果显示，法国肿瘤委员会在III期-N2 NSCLC的治疗管理方面存在显著差异，且决策未与地区条件相关。

Abstract

Management of stage-III-N2 non-small-cell lung cancer (NSCLC) based on a multimodal strategy (surgery or radiotherapycombined with systemic drugs) remains controversial. Patients are treated with a curative intent, and available data suggestprolonged survival after complete resection. However, no consensual definition of "tumor resectability" exists. This study aimed to analyze the concordanceamong French tumor board meeting (TBM)-emittedtherapeutic decisions forstage-III-N2 NSCLC.Six patients with stage-III-N2 NSCLC discussed at Saint-Etienne University Hospital'sthoracic TBMs were selected, anonymouslyreported, and submitted to the participating TBMs. The primary goal of this multicenter, prospective, observational study was to assess the consistency of TBMpanel decisions for each case. The secondary endpointwas identifying the demographic or technical factors that potentiallyaffected decision-making.Twenty-seven TBMs from university hospitals, a cancer center, general hospitals, and a private hospitalparticipated in this study. None of their decisions for the six cases were unanimous.The decisions were homogenous for three cases (78%, 85%, and 88% TBMs opted for medical treatment, respectively),andmore ambivalent for the other three (medical versus surgical strategies were favored by 44%/56%, 46%/54%, and 58%/42% TBMs, respectively). Interestingly, decisions regarding chemoradiationand perioperative chemotherapyinthe medical and surgical strategies, respectively, were also discordant. Hospital type, specialist participation in TBMs, and activity volumes were not significantly associated with therapeutic decisions.The results of this study highlight substantial disparities amongFrench TBMs regarding therapeutic management of stage-III-N2 NSCLC. The decisions were not associated with local conditions.