Long-Term Results of the International Adjuvant Lung Cancer Trial Evaluating Adjuvant Cisplatin-Based Chemotherapy in Resected Lung Cancer

被引:304
作者
Arriagada, Rodrigo [1 ]
Dunant, Ariane
Pignon, Jean-Pierre
Bergman, Bengt
Chabowski, Mariusz
Grunenwald, Dominique
Kozlowski, Miroslaw
Le Pechoux, Cecile
Pirker, Robert
Pinel, Maria-Izabel Sathler
Tarayre, Michele
Le Chevalier, Thierry
机构
[1] Inst Gustave Roussy, F-94800 Villejuif, France
关键词
VINORELBINE PLUS CISPLATIN; POOLED ANALYSIS; FOLLOW-UP; STAGE-II; THERAPY; METAANALYSES; RADIOTHERAPY; SURGERY; NSCLC;
D O I
10.1200/JCO.2009.23.2272
中图分类号
R73 [肿瘤学];
学科分类号
100214 ;
摘要
Purpose Based on 5-year or shorter-term follow-up data in recent randomized trials, adjuvant cisplatin-based chemotherapy is now generally recommended after complete surgical resection for patients with non-small-cell lung cancer (NSCLC). We evaluated the results of the International Adjuvant Lung Cancer Trial study with three additional years of follow-up. Patients and Methods Patients with completely resected NSCLC were randomly assigned to three or four cycles of cisplatin-based chemotherapy or to observation. Cox models were used to evaluate treatment effect according to follow-up duration. Results The trial included 1,867 patients with a median follow-up of 7.5 years. Results showed a beneficial effect of adjuvant chemotherapy on overall survival (hazard ratio [HR], 0.91; 95% CI, 0.81 to 1.02; P = .10) and on disease-free survival (HR, 0.88; 95% CI, 0.78 to 0.98; P = .02). However, there was a significant difference between the results of overall survival before and after 5 years of follow-up (HR, 0.86; 95% CI, 0.76 to 0.97; P = .01 v HR, 1.45; 95% CI, 1.02 to 2.07; P = .04) with P = .006 for interaction. Similar results were observed for disease-free survival. The analysis of non-lung cancer deaths for the whole period showed an HR of 1.34 (95% CI, 0.99 to 1.81; P = .06). Conclusion These results confirm the significant efficacy of adjuvant chemotherapy at 5 years. The difference in results beyond 5 years of follow-up underscores the need for the long-term follow-up of other adjuvant lung cancer trials and for a better identification of patients deriving long-term benefit from adjuvant chemotherapy.
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页码:35 / 42
页数:8
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