1Department of Oncology & Hematology, Beijing Hospital of Traditional Chinese Medicine, Capital Medical University; and.
2Graduate School, China Academy of Chinese Medical Sciences, Beijing, China.
J Natl Compr Canc Netw. 2020 Jun;18(6):718-727. doi: 10.6004/jnccn.2020.7537.
The role of postoperative radiotherapy (PORT) in patients with resected stage IIIA non-small cell lung cancer (NSCLC) remains controversial. The purpose of this study was to explore the effect of PORT on survival of these patients.
Patients aged ≥18 years with stage IIIA NSCLC were identified in the SEER database from 2010 through 2015. Cox regression analysis was used to identify independant prognostic factors in patients with stage IIIA NSCLC. Subgroup analysis of patients stratified by N stage was also performed. Overall survival and lung cancer-related death were compared among the different groups by using Kaplan-Meier analysis and competitive risk analysis.
A total of 5,168 patients (1,711 of whom received PORT) were included in the study. In multivariable analysis, PORT was an independent prognostic risk factor for patients with N1 stage (hazard ratio [HR], 1.416, 95% CI, 1.144-1.753; P=.001). PORT was a favorable prognostic factor for patients with stage IIIA, N2 disease with ≥6 positive lymph nodes (HR, 0.742; 95% CI, 0.587-0.938; P=.012). Median survival time of patients with stage IIIA, N2 disease with ≥6 positive lymph nodes who received postoperative chemotherapy combined with PORT was significantly longer compared with those who received postoperative chemotherapy alone (32 vs 25 months, respectively; P=.009). The competitive risk model revealed that 3- and 5-year lung cancer-related mortality rates increased by 8.99% and 16.92%, respectively, in patients with N1 disease who were treated with PORT, whereas the 3-year mortality rate decreased by 4.67% and the 5-year mortality rate by 10.08% in patients with N2 disease and ≥6 positive lymph nodes who were treated using PORT.
Our results revealed that PORT significantly improved overall survival and decreased lung cancer-related mortality in patients with stage IIIA, N2 disease with ≥6 positive lymph node metastases. PORT was not recommended for patients with N0 and N1 disease.
术后放疗（PORT）在接受根治性手术的 IIIA 期非小细胞肺癌（NSCLC）患者中的作用仍存在争议。本研究旨在探讨 PORT 对这些患者生存的影响。
从 SEER 数据库中检索 2010 年至 2015 年期间年龄≥18 岁的 IIIA 期 NSCLC 患者。采用 Cox 回归分析识别 IIIA 期 NSCLC 患者的独立预后因素。还对 N 分期亚组进行了亚组分析。采用 Kaplan-Meier 分析和竞争风险分析比较不同组间的总生存和肺癌相关死亡。
共纳入 5168 例患者（1711 例接受 PORT）。多变量分析显示，N1 期患者 PORT 是独立的预后危险因素（风险比[HR]，1.416；95%CI，1.144-1.753；P=.001）。PORT 是 IIIA 期、N2 期且阳性淋巴结≥6 个的患者的有利预后因素（HR，0.742；95%CI，0.587-0.938；P=.012）。接受术后化疗联合 PORT 的 IIIA 期、N2 期且阳性淋巴结≥6 个的患者中位生存时间明显长于仅接受术后化疗的患者（32 个月比 25 个月，P=.009）。竞争风险模型显示，N1 期患者接受 PORT 治疗后，3 年和 5 年的肺癌相关死亡率分别增加 8.99%和 16.92%，而 N2 期且阳性淋巴结≥6 个的患者接受 PORT 治疗后，3 年死亡率降低 4.67%，5 年死亡率降低 10.08%。
本研究结果显示，PORT 可显著改善 IIIA 期、N2 期且阳性淋巴结≥6 个的患者的总生存，并降低肺癌相关死亡率。不推荐 PORT 用于 N0 和 N1 期患者。
