Effectiveness of intensive clinical and radiological follow-up in patients with surgically resected NSCLC. Analysis of 2661 patients from the prospective MAGRIT trial
【MAGRIT】非小细胞肺癌手术切除术后强化临床及影像学随访的效果：前瞻性2661例分析
BACKGROUND:
Limited evidence is available on effectiveness of clinicoradiological follow-up of early-stage NSCLC patients. MAGRIT was a phase III adjuvant RCT conducted in surgically resected stage IB-IIIA NSCLC patients, in which all participants had a prospectively defined intensive clinicoradiological follow-up.
背景：对早期非小细胞肺癌患者的临床影像学随访的有效性证据有限。MAGRIT是一项Ⅲ期辅助性随机对照实验，纳入手术切除的IB-IIIA期NSCLC患者中进行，所有参与者都接受前瞻性的强化临床影像学随访。
METHODS:
At patient-level data, we analyzed detection modality of disease recurrences and new primary lung cancer (i.e. detected by clinicoradiological scheduled exams versus by interim unscheduled exams), features associated with higher risk of locoregional and/or distant recurrence, and recurrence rates over time.
方法：在以患者水平的数据中，作者分析了复发和新原发性肺癌的检测方式（即通过定期的临床影像学检查和临时非定期检查），与较高的局部和/或远处复发风险相关的特征，以及随时间推移的复发率。
RESULTS:
In the 2261 patients studied, there was a significant association between the type of recurrence and the modality of detection: 88.4% (95% CI, 84%-91%) of the locoregional recurrences and 93.2% (95% CI, 84%-99%) of the new primary lung cancers were detected by scheduled exams, whereas this was only 68.7% (95% CI, 65%-73%) for distant metastases (p < 0.001). Survival of patients with locoregional recurrence or new primary lung cancer detected by scheduled exams was significantly better as compared with those detected by unscheduled exams (HR 0.56, 95% CI 0.36-0.87; p = 0.01). Survival was similarly poor in patients with distant recurrences, both with scheduled and unscheduled detection (3-year survival after recurrence 22.0% and 21.8%, respectively). Recurrence rate was the highest in the first 18 months after surgery-with a peak between month 6 and 12-decreasing thereafter. The hazard of a second primary lung cancer was constant over time.
结果：在2261例患者中，复发类型与检测方式显著相关：88.4%（95%置信区间[CI]，84%-91%）的局部复发和93.2%（95%CI，84%-99%）的新原发肺癌是通过定期检查检测出来的，而仅有68.7%（95%CI，65%-73%）的远处转移能通过定期检查检测出来（p<0.001）。定期检查发现局部复发或新发原发性肺癌患者的生存率明显高于非定期检查发现的患者（危害比[HR] 0.56，95%CI 0.36-0.87；p=0.01）。有远处复发的患者无论是定期检查还是非定期检查发现的生存率都很低（复发后3年生存率分别为22.0%和21.8%）。术后18个月复发率最高，术后6～12个月达高峰，之后降低。随着时间的推移，第二原发肺癌的风险是恒定的。
CONCLUSION:
Intensive follow-up is effective in detecting locoregional recurrences and second primary lung cancers, with impact on patients' survival but did not influence the detection of distant recurrences.
结论：强化随访对发现局部复发和第二原发肺癌有效，对患者生存有影响，但不影响远处复发的发现。
Conforti F, Pala L, Pagan E, Bagnardi V, Zagami P, Spaggiari L, Catania C, Vansteenkiste J, Giaccone G, De Pas T. Effectiveness of intensive clinical and radiological follow-up in patients with surgically resected NSCLC. Analysis of 2661 patients from the prospective MAGRIT trial. Eur J Cancer. 2020 Jan;125:94-103. doi: 10.1016/j.ejca.2019.11.005. Epub 2019 Dec 13. PMID: 31841793.
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