Department of Radiation Oncology.
Department of VIP Medical Services, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.
Thorac Cancer. 2021 Jan;12(2):227-234. doi: 10.1111/1759-7714.13749. Epub 2020 Nov 27.
BACKGROUND: The aim of this study was to evaluate the efficacy of postoperative radiotherapy (PORT) in stage pIIIA-N2 non-small cell lung cancer (NSCLC) patients with positive surgical margins. METHODS: Between January 2003 and December 2015, patients who had undergone lobectomy or pneumonectomy plus mediastinal lymph node dissection or systematic sampling in our single institution were retrospectively reviewed. Those with pIIIA-N2 NSCLC and positive surgical margins were enrolled into the study. The Kaplan-Meier method was used for survival analysis, and the log-rank test was used to analyze differences between the groups. Univariate and multivariate analyses using Cox proportional hazards regression models were performed to evaluate potential prognostic factors for OS. Statistically significant difference was set as P < 0.05. RESULTS: Of all the 1547 patients with pIIIA-N2 NSCLC reviewed, 113 patients had positive surgical margins, including 76 patients with R1 resection and 37 with R2 resection. The median overall survival (OS) was 28.3 months in the PORT group and 22.6 months in the non-PORT group (P = 0.568). Subset analysis showed that for patients with R1 resection, the median OS was 52.4 months in the PORT group which was nonsignificantly longer than that of 22.6 months in the non-PORT group (P = 0.127), whereas PORT combined with chemotherapy could significantly improve OS, with a median OS of 52.4 months versus 17.2 months (P = 0.027). For patients with R2 resection, PORT made no significant difference in OS (17.6 vs. 63.8 months, P = 0.529). CONCLUSIONS: For pIIIA-N2 NSCLC patients with positive surgical margins, PORT did not improve OS, but OS was improved in those patients who underwent R1 resection combined with chemotherapy. KEY POINTS: SIGNIFICANT FINDINGS OF THE STUDY: Significant findings of the study: Postoperative radiotherapy (PORT) has been recommended to treat patients with positive surgical margins. However, the existing evidence is controversial and high-level evidence is lacking. WHAT THIS STUDY ADDS: What this study adds: The PORT group had markedly, but not statistically significant, longer median OS compared with the non-PORT group in patients with R1 resection. OS was significantly longer in the patients with R1 resection receiving adjuvant CRT than the surgery alone group.
背景：本研究旨在评估术后放疗（PORT）在切缘阳性的 IIIA-N2 期非小细胞肺癌（NSCLC）患者中的疗效。
方法：回顾性分析 2003 年 1 月至 2015 年 12 月在我院行肺叶切除术或全肺切除术加纵隔淋巴结清扫术或系统性取样的患者。纳入 IIIA-N2 NSCLC 且切缘阳性的患者。采用 Kaplan-Meier 法进行生存分析，组间差异采用对数秩检验。采用 Cox 比例风险回归模型进行单因素和多因素分析，评估 OS 的潜在预后因素。具有统计学意义的差异设定为 P < 0.05。
结果：在所有 1547 例 IIIA-N2 NSCLC 患者中，113 例患者切缘阳性，其中 76 例为 R1 切除术，37 例为 R2 切除术。PORT 组和非 PORT 组的中位总生存期（OS）分别为 28.3 个月和 22.6 个月（P = 0.568）。亚组分析显示，对于 R1 切除术患者，PORT 组的中位 OS 为 52.4 个月，长于非 PORT 组的 22.6 个月（P = 0.127），而 PORT 联合化疗可显著改善 OS，中位 OS 为 52.4 个月 vs. 17.2 个月（P = 0.027）。对于 R2 切除术患者，PORT 对 OS 无显著影响（17.6 个月比 63.8 个月，P = 0.529）。
结论：对于切缘阳性的 IIIA-N2 NSCLC 患者，PORT 并不能提高 OS，但 R1 切除术联合化疗可提高 OS。
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