Department of Radiation Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.
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 May;12(9):1358-1365. doi: 10.1111/1759-7714.13908. Epub 2021 Mar 16.
In this study, we aimed to investigate the association between postoperative radiotherapy (PORT) and cardiac-related mortality in patients with stage IIIA-N2 non-small cell lung cancer (NSCLC) using the Surveillance, Epidemiology, and End Results (SEER) database.
The United States (US) population based on the SEER database was searched for cardiac-related mortality among patients with stage IIIA-N2 NSCLC. Cardiac-related mortality was compared between the PORT and Non-PORT groups. Accounting for mortality from other causes, Fine and Gray's test compared cumulative incidences of cardiac-related mortality between both groups. Univariate and multivariate analysis were performed using the competing risk model.
From 1988 to 2016, 7290 patients met the inclusion criteria: 3386 patients were treated with PORT and 3904 patients with Non-PORT. The five-year overall incidence of cardiac-related mortality was 3.01% in the PORT group and 3.26% in the Non-PORT group. Older age, male sex, squamous cell lung cancer, earlier year of diagnosis and earlier T stage were independent adverse factors for cardiac-related mortality. However, PORT use was not associated with an increase in the hazard for cardiac-related mortality (subdistribution hazard ratio [SHR] = 0.99, 95% confidence interval [CI]: 0.78-1.24, p = 0.91). When evaluating cardiac-related mortality in each time period, the overall incidence of cardiac-related mortality was decreased over time. There were no statistically significant differences based on PORT use in all time periods.
With a median follow-up of 25 months, no significant differences were found in cardiac-related mortality between the PORT and Non-PORT groups in stage IIIA-N2 NSCLC patients.
本研究旨在利用美国监测、流行病学和最终结果（SEER）数据库，探讨术后放疗（PORT）与 IIIA-N2 期非小细胞肺癌（NSCLC）患者心脏相关死亡率之间的关系。
利用 SEER 数据库对 IIIA-N2 期 NSCLC 患者的心脏相关死亡率进行了美国人群的检索。PORT 组与 Non-PORT 组的心脏相关死亡率进行了比较。在考虑其他原因导致的死亡率的情况下，Fine 和 Gray 检验比较了两组之间心脏相关死亡率的累积发生率。使用竞争风险模型进行单变量和多变量分析。
1988 年至 2016 年，共有 7290 例患者符合纳入标准：3386 例患者接受 PORT 治疗，3904 例患者接受 Non-PORT 治疗。PORT 组和 Non-PORT 组的五年心脏相关死亡率分别为 3.01%和 3.26%。年龄较大、男性、鳞状细胞肺癌、诊断较早和 T 分期较早是心脏相关死亡率的独立不良因素。然而，PORT 的使用与心脏相关死亡率的危险增加无关（亚分布危险比 [SHR] = 0.99，95%置信区间 [CI]：0.78-1.24，p = 0.91）。在评估每个时间段的心脏相关死亡率时，随着时间的推移，心脏相关死亡率的总体发生率呈下降趋势。在所有时间段内，PORT 的使用与心脏相关死亡率均无统计学差异。
中位随访 25 个月时，在 IIIA-N2 期 NSCLC 患者中，PORT 组与 Non-PORT 组之间的心脏相关死亡率无显著差异。
