Pushing forward into the darkness, leaping, and landing securely: prognostication and adjuvant chemotherapy for lung cancer.

摘要

The study by Maeda et al in this issue of CHEST (see page 1494) analyzes patients with stage I and II non-small cell lung cancer (NSCLC) and finds that subsets of these patients have a different risk of recurrence (according to histologic differentiation, vessel invasion, visceral pleural invasion, and adeno-carcinoma histology). The authors suggest that such risk stratification could help select patients for adjuvant chemotherapy.This article is worthy of attention for several reasons. It explores a relevant clinical question: We know that adjuvant chemotherapy after resection can be beneficial, but do we know which patients to give it to? It involves a large cohort (1,967 patients) and a detailed multivariate analysis. The focus on the end point of freedom from recurrence is notable. This is better than overall survival for this question because nearly 50% of patients with early-stage NSGLC die of unrelated causes, which will not be affected by chemotherapy.