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. 2022 Feb;13(3):404-411. doi: 10.1111/1759-7714.14273. Epub 2021 Dec 14.
For patients with ypN2 non-small cell lung cancer (NSCLC) after neoadjuvant chemotherapy followed by surgery (NCS), the role of postoperative radiotherapy (PORT) is unclear. The aim of our study was to evaluate the effect of PORT on survival of ypN2 NSCLC patients after NCS.
Between 2004 and 2015, patients with ypN2 NSCLC after NCS were filtrated from the Surveillance, Epidemiology, and End Results (SEER) database. Propensity score matching (PSM) was used to balance the baseline characteristics of the PORT and non-PORT groups. Kaplan-Meier method and Cox proportional hazards models were adopted to estimate overall survival (OS) and cancer-specific survival (CSS).
A total of 257 patients who met the criteria were included in the study. After PSM, 115 patients remained in each group. The survival of patients in the PORT group was significantly better than those in the non-PORT group. Median OS was 36 months vs. 26 months, and 5-year OS rate was 40.5% vs. 21.0% (p = 0.002). The median CSS was 38 months vs. 27 months, and the 5-year CSS rate was 43.7% vs. 22.1% (p < 0.001). Multivariable analysis showed that PORT was an independent prognostic factor for OS (HR = 0.59, 95% CI: 0.43-0.82, p = 0.001) and CSS (HR = 0.56, 95% CI: 0.41-0.78, p = 0.001). Subgroup analysis showed that patients in the following subgroups could benefit from PORT: age ≤ 70, diagnosed in the later period (2010-2015), white race, squamous cell carcinoma, grade III-IV, lobectomy, stage T3-4, or with positive regional nodes ≤3 or > 3.
For patients with ypN2 NSCLC after NCS, PORT significantly improves OS and CSS. These results need to be confirmed by further randomized studies.
对于接受新辅助化疗后行手术治疗（NCS）的 ypN2 非小细胞肺癌（NSCLC）患者，术后放疗（PORT）的作用尚不清楚。我们的研究目的是评估 PORT 对 NCS 后 ypN2 NSCLC 患者生存的影响。
本研究从监测、流行病学和最终结果（SEER）数据库中筛选出接受 NCS 后 ypN2 NSCLC 的患者。采用倾向评分匹配（PSM）来平衡 PORT 和非 PORT 组的基线特征。采用 Kaplan-Meier 法和 Cox 比例风险模型来估计总生存期（OS）和癌症特异性生存期（CSS）。
共纳入符合条件的 257 例患者。PSM 后，每组各有 115 例患者。PORT 组患者的生存情况明显优于非 PORT 组。中位 OS 为 36 个月 vs. 26 个月，5 年 OS 率为 40.5% vs. 21.0%（p=0.002）。中位 CSS 为 38 个月 vs. 27 个月，5 年 CSS 率为 43.7% vs. 22.1%（p<0.001）。多变量分析显示，PORT 是 OS（HR=0.59，95%CI：0.43-0.82，p=0.001）和 CSS（HR=0.56，95%CI：0.41-0.78，p=0.001）的独立预后因素。亚组分析显示，以下亚组的患者可以从 PORT 中获益：年龄≤70 岁、诊断时间较晚（2010-2015 年）、白种人、鳞癌、分级 III-IV 级、肺叶切除术、T3-4 期或阳性区域淋巴结≤3 个或>3 个。
对于接受 NCS 的 ypN2 NSCLC 患者，PORT 可显著提高 OS 和 CSS。这些结果需要进一步的随机研究来证实。
