Survival Benefit of Uracil-Tegafur (UFT) for AJCC 7^(th) Pathologic Stage IB Non-Small Cell Lung Cancer Patients: A Propensity Score Matching Study

友復（UFT）對於Stage IB非小細胞肺癌病患術後的生存益處評估

吳青峰(Ching-Feng Wu) ； 傅瑞英(Jui-Ying Fu) ； 王志偉(Chi-Wei Wang) ； 劉永恆(Yun-Hen Liu) ； 謝明儒(Ming-Ju Hsieh) ； 吳青陽(Ching-Yang Wu) ； 吳怡成(Yi-Cheng Wu) ； 劉會平(Hui-Ping Liu)

《胸腔醫學》 30卷4期 (2015/08) Pp. 191-200

摘要

目的：對於Stage IB的病患使用友復膠囊作為術後追加的化學治療在台灣以及日本都被廣泛的討論及使用，本篇論文所要討論的就是對於第七版的AJCC分期的IB 病患，使用友復膠囊對於病患生存的益處評估。方法：我們回溯性的分析220位原本在第六版的AJCC分期裡IB的病患重新依據第七版的AJCC分期條件及利用傾向分數（propensity score）1:4作為分類的方式選出130位病患分成兩組：術後使用友復膠囊的病患26位，沒有使用友復膠囊的病患104位，對於這整群的IB病患做預後危險因子分析：包括年紀、性別、手術方式、細胞種類、臟器肋膜的侵犯，以及血管淋巴管侵犯。結果：根據本文的統計結果，腫瘤大小小於3公分跟接受友復（UFT）治療的非小胞肺癌IB病患有較好的存活率。在多重變數分析中，腫瘤大於3公分為負向存活指標，（勝算比odds ratio=3.496; 95%confidence interval, 1.49-8.20），有服用友復的IB病患則有較好的存活率（odds ratio=0.180; 95% confidenceinterval, 0.049-0.660），如果大於3公分的病患接受過友復膠囊治療，存活率也較無接受治療的病患好（p=0.041）。結論：總結而言，對於IB病患術後服用友復（UFT）的確能增加病患的生存率，且對於大於3公分的IB病患也能增加術後的存活時間。

關鍵字

非小細胞肺癌 ； 分期IB ； 友復膠囊 ； 化療

並列摘要

Purpose: Adjuvant chemotherapy with uracil-tegafur (UFT) is widely used for pathologic stage IB (pIB) non-small cell lung cancer (NSCLC) in Taiwan and Japan. The aim of this study was to identify the survival benefit for patients with and without UFT treatment. Methods: We performed a retrospective review of 220 patients with stage pIB disease (using the 6th American Joint Committee on Cancer (AJCC 6^(th)) Cancer Staging Manual) who underwent lung resection from January 2005 to July 2012. All patients were reclassified using the AJCC 7^(th) cancer staging system, and 130 matched subjects were included. Using a propensity score matching method (1:4 match), patients with stage pIB disease were divided into 2 groups (UFT: 26, Non-UFT: 104). The oral dose of UFT was 400 mg/body. Multiple risk factors were analyzed, including age, gender, surgical method, cell type, visceral pleural invasion, and angiolymphatic invasion. The 2 study groups were well matched with respect to age, gender, surgical method (video-assisted thoracoscopic surgery or open thoracotomy), and pathological parameters, including cell type, visceral pleural invasion, and angiolymphatic invasion. Results: A tumor diameter greater than 3 cm was a poor prognostic factor for overall survival of patients with stage pIB NSCLC. The survival rate was significantly higher in the UFT group than in the surgery-alone group. Multivariate analyses revealed that a tumor diameter ＞3 cm (odds ratio=3.496; 95% confidence interval, 1.49-8.20) and use of UFT (odds ratio=0.180; 95% confidence interval, 0.049-0.660) were predictive of overall survival. The overall survival of patients with a tumor diameter ＞3 cm who were treated with UFT was better than the overall survival of those not treated with UFT. (p=0.041) Conclusion: In conclusion, UFT treatment was shown to prolong the overall survival of patients with newly diagnosed stage pIB NSCLC in our study. In addition, patients with a tumor diameter ＞3 cm had poor overall survival, but could obtain a survival benefit after completing 2 years of UFT treatment.

並列關鍵字

non-small cell lung cancer ； stage IB ； uracil-tegafur ； chemotherapy