pIIIa-N2 期非小细胞肺癌患者术后放疗作用再评价：倾向评分匹配分析。
Reappraisal of the role of postoperative radiation therapy in patients with pIIIa-N2 non-small cell lung cancer: A propensity score matching analysis.
机构信息
Key Laboratory of Cancer Prevention and Therapy, Department of Radiotherapy, National Clinical Research Center for Cancer, Tianjin Medical University Cancer Institute and Hospital Tianjin, China.
Key Laboratory of Cancer Prevention and Therapy, Department of Lung Cancer Surgery, National Clinical Research Center for Cancer, Tianjin Medical University Cancer Institute and Hospital Tianjin, China.
出版信息
Thorac Cancer. 2015 Sep;6(5):570-8. doi: 10.1111/1759-7714.12224. Epub 2015 Jan 29.
BACKGROUND
Reappraisal of the role of postoperative radiotherapy in pN2 non-small cell lung cancer (NSCLC) patients according to N1 lymph node involvement.
METHODS
A total of 218 pIIIa-N2 NSCLC patients who underwent complete surgical resection with systematic nodal dissections were enrolled. Propensity scores were used for matching N1 involvement. Overall survival (OS) and disease-free survival (DFS) were analyzed retrospectively.
RESULTS
After matching, pN2b patients without N1 involvement (pN0N2b) exhibited better prognoses than those with N1 involvement (pN1N2b) (5-year OS: 37.5% vs. 7.1%, P = 0.008; 5-year DFS: 31.8% vs. 4.6%, P = 0.004). Similar results were not detected in pN2a disease (5-year OS: 37.8% vs. 31.0%, P = 0.517; 5-year DFS: 27.1% vs. 20.2%, P = 0.788). The five-year OS of patients who received no adjuvant therapy (22 pN2a cases, 7 pN0N2b, 5 pN1N2b), adjuvant chemotherapy alone (74 pN2a cases, 11 pN0N2b, 17 pN1N2b) or chemoradiotherapy (25 pN2a cases, 7 pN0N2b, 6 pN1N2b) were compared (pN2a: 31.3%, 37.0%, and 32.0%, P = 0.808; pN0N2b: 0.0%, 18.2%, and 71.4%, P = 0.108; pN1N2b: 0.0%, 0.0%, and 33.3%, P < 0.0001). The five-year DFS was also analyzed (pN2a: 31.6%, 24.0%, and 18.3%, P = 0.410; pN0N2b: 0.0%, 11.1%, and 57.1%, P = 0.192; pN1N2b: 0.0%, 0.0%, and 16.7%, P < 0.0001). Multivariate analysis revealed that the novel classification based on N1 involvement and pN2a/pN2b staging was an independent prognostic factor of OS and DFS.
CONCLUSION
N1 involvement significantly impacted the prognosis of pN2b NSCLC patients. The benefit of adjuvant therapy in pN2a and pN0N2b patients requires confirmation by further study.
背景
根据 N1 淋巴结受累情况，重新评估术后放疗在 pN2 非小细胞肺癌（NSCLC）患者中的作用。
方法
共纳入 218 例接受完全手术切除和系统淋巴结清扫术的 pIIIa-N2 NSCLC 患者。采用倾向评分匹配 N1 受累情况。回顾性分析总生存（OS）和无病生存（DFS）。
结果
匹配后，无 N1 受累的 pN2b 患者（pN0N2b）预后优于有 N1 受累的患者（pN1N2b）（5 年 OS：37.5% vs. 7.1%，P = 0.008；5 年 DFS：31.8% vs. 4.6%，P = 0.004）。在 pN2a 疾病中未发现类似结果（5 年 OS：37.8% vs. 31.0%，P = 0.517；5 年 DFS：27.1% vs. 20.2%，P = 0.788）。未接受辅助治疗（22 例 pN2a 病例、7 例 pN0N2b、5 例 pN1N2b）、单独接受辅助化疗（74 例 pN2a 病例、11 例 pN0N2b、17 例 pN1N2b）或放化疗（25 例 pN2a 病例、7 例 pN0N2b、6 例 pN1N2b）的患者 5 年 OS 比较（pN2a：31.3%、37.0%和 32.0%，P = 0.808；pN0N2b：0.0%、18.2%和 71.4%，P = 0.108；pN1N2b：0.0%、0.0%和 33.3%，P < 0.0001）。还分析了 5 年 DFS（pN2a：31.6%、24.0%和 18.3%，P = 0.410；pN0N2b：0.0%、11.1%和 57.1%，P = 0.192；pN1N2b：0.0%、0.0%和 16.7%，P < 0.0001）。多因素分析显示，基于 N1 受累和 pN2a/pN2b 分期的新分类是 OS 和 DFS 的独立预后因素。
结论
N1 受累显著影响 pN2b NSCLC 患者的预后。pN2a 和 pN0N2b 患者辅助治疗的获益需要进一步研究证实。
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