Lin Shih-Min, Ku Hsiu-Ying, Hsu Che-Yu, Wang Chih-Liang, Chang Gee-Chen, Chang Cheng-Shyong, Liu Tsang-Wu
Department of Radiation Oncology, Chang Gung Memorial Hospital at Linkou, Taoyuan 333, Taiwan.
National Institute of Cancer Research, National Health Research Institute, Miaoli 350, Taiwan.
Cancers (Basel). 2021 May 20;13(10):2494. doi: 10.3390/cancers13102494.
(1) Purpose: To investigate the effects of the time interval between initiation of adjuvant chemotherapy and radiotherapy on survival outcomes in patients with completely resected stage IIIA pN2 non-small-cell lung cancer (NSCLC); (2) Methods: Data on 2515 patients with completely resected stage IIIA pN2 NSCLC in 2007-2017 were extracted from the Taiwan Cancer Registry Database. The survival outcomes in patients who underwent concurrent chemoradiotherapy (CCRT) and sequential chemotherapy and radiotherapy (SCRT) with either a short (SCRT1) or long (SCRT2) interval between treatments were estimated using Kaplan-Meier, Cox regression, and propensity score matching (PSM); (3) Results: Multivariate analyses of OS showed that SCRT2 (hazard ratio [HR] 0.64, = 0.017) was associated with improved overall survival (OS). After PSM, the median OS periods were 64 and 75 months in the SCRT1 and SCRT2 groups, respectively, which differed significantly from that of 58 months in the CCRT group ( = 0.003). In elderly patients, SCRT2 significantly improved survival relative to CCRT before PSM ( = 0.024) and after PSM ( = 0.002); (4) Conclusions: A longer interval between initiation of adjuvant chemotherapy and postoperative radiotherapy (PORT; SCRT2) improved OS relative to CCRT; the benefits were greater in elderly patients (age >60 years).
(1) 目的：探讨完全切除的IIIA期pN2非小细胞肺癌（NSCLC）患者辅助化疗与放疗起始时间间隔对生存结局的影响；(2) 方法：从台湾癌症登记数据库中提取2007 - 2017年2515例完全切除的IIIA期pN2 NSCLC患者的数据。采用Kaplan - Meier法、Cox回归和倾向评分匹配（PSM）评估接受同步放化疗（CCRT）以及序贯化疗和放疗（SCRT，治疗间隔短[SCRT1]或长[SCRT2]）患者的生存结局；(3) 结果：OS的多因素分析显示，SCRT2（风险比[HR] 0.64，P = 0.017）与总生存期（OS）改善相关。PSM后，SCRT1组和SCRT2组的中位OS期分别为64个月和75个月，与CCRT组的58个月有显著差异（P = 0.003）。在老年患者中，PSM前（P = 0.024）和PSM后（P = 0.002），SCRT2相对于CCRT均显著改善了生存；(4) 结论：辅助化疗与术后放疗（PORT；SCRT2）起始时间间隔较长相对于CCRT可改善OS；在老年患者（年龄>60岁）中获益更大。
