The Cancer Center of the Fifth Affiliated Hospital of Sun Yat-Sen University, Zhuhai, China.
Guangdong Provincial Key Laboratory of Biomedical Imaging, The Fifth Affiliated Hospital, Sun Yat-sen University, Zhuhai, China.
Cancer Med. 2020 Apr;9(8):2820-2832. doi: 10.1002/cam4.2937. Epub 2020 Feb 26.
To determine the postoperative effects of radiotherapy (PORT) on the local recurrence-free survival (LRFS) and overall survival (OS) of stage III-N2 non-small-cell lung cancer (NSCLC).
183 patients with resected stage III-pN2 NSCLC from Hunan Cancer Hospital between 2013 and 2016 were divided into two groups for postoperative chemotherapy (POCT) (n = 105) or combination chemotherapy and radiotherapy (POCRT) (n = 78). The LRFS and OS were compared and the factors affecting local recurrence were illustrated in these two groups. The sites of failure based on the lobe of the primary tumor in two groups were described.
PORT leads to a strikingly lower risk for local recurrence and brought superior OS benefit. For different pN2 Subclassification, Patients with multiple-station pN2 ± pN1 disease had the worst LRFS (11 months) and single-station pN2 + multiple station pN1 disease had a relatively short LRFS (24 months) in group POCT. Short LRFS is correlated with multiple-station pN2, older age (Y > 55), patients with a high positive LN ratio > 1/3 and a poor tumor histological differentiation degree. In group POCT, the most frequent failure site occurs at the ipsilateral hilum (21.0%), the bronchial stump (20.0%), followed by LNs4R (19.0%), LNs4L (18.1%), LNs7 (15.2%), most of left-sided tumors more frequently involved the contralateral mediastinum, whereas the ipsilateral recurrences dominated for right-sided tumors, especially for LNs4R. In group POCRT, the highest failure site was the bronchial stump (11.5%), followed by LNs4L (8.97%), LNs1 (7.69%), the ipsilateral hilum (6.41%) and LNs4R (6.41%).
PORT remarkably reduced local recurrence and improved OS in stage III-pN2 NSCLC, especially in the multiple-station pN2 group.
探讨术后放疗（PORT）对 III-N2 期非小细胞肺癌（NSCLC）局部无复发生存（LRFS）和总生存（OS）的影响。
回顾性分析 2013 年至 2016 年湖南省肿瘤医院收治的 183 例 III 期 pN2 NSCLC 患者，术后分为单纯化疗组（POCT）（n=105）和化疗联合放疗组（POCRT）（n=78），比较两组患者的 LRFS 和 OS，分析局部复发的影响因素，描述两组患者以原发肿瘤叶为基础的失败部位。
PORT 可显著降低局部复发风险，提高 OS 获益。对于不同的 pN2 亚组分类，POCT 组中多站 pN2±pN1 患者 LRFS 最差（11 个月），单站 pN2+多站 pN1 患者 LRFS 较短（24 个月）。LRFS 较短与多站 pN2、年龄较大（Y>55 岁）、阳性淋巴结比率较高（>1/3）和肿瘤组织学分化程度差相关。POCT 组中最常见的失败部位为同侧肺门（21.0%）、支气管残端（20.0%），其次为 4R 区淋巴结（19.0%）、4L 区淋巴结（18.1%）、7 区淋巴结（15.2%），左侧肿瘤更易累及对侧纵隔，而右侧肿瘤以同侧复发为主，特别是 4R 区淋巴结。POCRT 组中，支气管残端的失败率最高（11.5%），其次为 4L 区淋巴结（8.97%）、1 区淋巴结（7.69%）、同侧肺门（6.41%）和 4R 区淋巴结（6.41%）。
PORT 可显著降低 III 期 pN2 NSCLC 患者的局部复发率，提高 OS，特别是在多站 pN2 患者中。
