Two-year survival and disease recurrence after endosonography with or without confirmatory mediastinoscopy for resectable lung cancer (a short communication of the MEDIASTrial follow-up)

IF 4.5 2区医学 Q1 ONCOLOGY

Lung Cancer Pub Date : 2025-03-22 DOI:10.1016/j.lungcan.2025.108462

Jelle E. Bousema , Louisa N. Spaans , Marcel G.W. Dijkgraaf , Erik H.F.M. van der Heijden , Ad F.T.M. Verhagen , Jouke T. Annema , Frank J.C. van den Broek

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引用次数: 0

Abstract

Resectable non-small cell lung cancer (NSCLC) with increased risk of mediastinal nodal involvement requires invasive staging prior to surgical resection. The MEDIASTrial was a multicenter non-inferiority trial randomly assigning patients after negative endosonography to immediate lung tumor resection (n = 178) or to mediastinoscopy first (n = 182), only followed by tumor resection after negative mediastinoscopy. The omission of confirmatory mediastinoscopy after negative endosonography led to a clinically negligible and non-inferior increase in unforeseen N2.

We report the two-year overall and disease-free survival (OS and DFS) and the health-related quality-of-life (HRQoL) gathered with the QLQ-C30 and QLQ-LC13 questionnaires.

After randomization seven drop-outs were observed in both groups. Time to 80 % OS was 25 months in the immediate resection group versus 20 months in the mediastinoscopy group (adjusted HR 0.8, 95 % CI: 0.5–1.3). Time to 65 % DFS was 25 months in the immediate resection group versus 25 months in the mediastinoscopy group (adjusted HR 0.9, 95 % CI: 0.6–1.4). The HRQoL scores were comparable among the groups during the two-year follow-up.

The loss in diagnostic yield by omitting confirmatory mediastinoscopy after negative systematic endosonography has no impact on two-year OS, DFS and HRQoL in patients with resectable NSCLC and an indication for invasive mediastinal nodal staging.

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可切除肺癌患者接受或不接受纵隔镜检查后的两年生存率和疾病复发率（MEDIAST 试验随访简讯）

可切除的非小细胞肺癌（NSCLC）纵隔结节受累风险较高，需要在手术切除前进行侵入性分期。MEDIAST试验是一项多中心非劣效性试验，随机分配内镜检查阴性的患者立即进行肺部肿瘤切除术（n = 178）或先进行纵隔镜检查（n = 182），纵隔镜检查阴性后再进行肿瘤切除术。我们报告了两年的总生存期和无病生存期（OS和DFS），以及通过QLQ-C30和QLQ-LC13问卷调查获得的与健康相关的生活质量（HRQoL）。即刻切除术组的80%OS时间为25个月，而纵隔镜手术组为20个月（调整后HR为0.8，95% CI：0.5-1.3）。即刻切除术组的 65% DFS 为 25 个月，而纵隔镜手术组为 25 个月（调整后 HR 为 0.9，95 % CI 为 0.6-1.4）。在两年的随访中，各组的 HRQoL 评分相当。对于可切除 NSCLC 且有纵隔结节有创分期指征的患者来说，在系统性内窥镜检查阴性后省略纵隔镜确诊所造成的诊断率损失对两年的 OS、DFS 和 HRQoL 没有影响。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Lung Cancer 医学-呼吸系统

CiteScore

9.40

自引率

3.80%

发文量

407

审稿时长

25 days

期刊介绍： Lung Cancer is an international publication covering the clinical, translational and basic science of malignancies of the lung and chest region.Original research articles, early reports, review articles, editorials and correspondence covering the prevention, epidemiology and etiology, basic biology, pathology, clinical assessment, surgery, chemotherapy, radiotherapy, combined treatment modalities, other treatment modalities and outcomes of lung cancer are welcome.