Department of Thoracic Oncology, The Second Affiliated Hospital of Zun Yi Medical University, Zunyi, China.
Interact Cardiovasc Thorac Surg. 2022 Jun 15;35(1). doi: 10.1093/icvts/ivab321.
The aim of this study was to investigate the effect of preoperative radiotherapy (PrORT) on the overall survival (OS) of patients with stage ipsilateral mediastinal lymph node metastasis (N2) non-small-cell lung cancer.
A total of 1390 patients with stage N2 non-small-cell lung cancer between 2010 and 2015 were identified from the Surveillance, Epidemiology, and End Results database. The efficacy of PrORT combined with surgery was compared with that of surgery alone on OS. Propensity score matching (PSM) was performed to balance the baseline characteristics of patients who received (n = 239) and did not receive (n = 1151) PrORT. We compared the OS of the 2 groups using the Kaplan-Meier method and log-rank were used to compare the OS between the 2 groups test before and after PSM and to analyse subgroups of patients with squamous cell carcinoma (SCC) and adenocarcinoma.
In whole group analysis before PSM, the median OS was superior in the PrORT group than in the surgery alone group (44.0 [34.4-56.6] vs 39.0 [34.5-43.5] months). There was a significant difference in OS [hazard ratio (HR): 0.819; 95% confidence interval (CI): 0.677-0.991; P = 0.029]. Nevertheless, no statistically significant difference was found in OS between the 2 groups after PSM (HR: 0.856; 95% CI: 0.654-1.122; P = 0.260). Among subgroup analysis of the SCC group before PSM revealed that patients who received PrORT had significantly higher median OS than those who did not receive PrORT (52.0 [40.0-NA] vs 27.0 [22.0-32.0] months; HR: 0.591, 95% CI: 0.442-0.792, P = 0.000) and the differences in OS existed after PSM (P = 0.043). However, no significant difference was found in OS before and after matching in the adenocarcinoma group (P = 0.827 and P = 0.801, respectively).
PrORT demonstrated an OS benefit for patients with stage N2 lung SCC; however, further prospective randomized clinical trials are warranted to confirm this finding.
本研究旨在探讨术前放疗（PrORT）对同侧纵隔淋巴结转移（N2）非小细胞肺癌患者总生存期（OS）的影响。
从 Surveillance, Epidemiology, and End Results 数据库中确定了 2010 年至 2015 年间 1390 名 N2 期非小细胞肺癌患者。比较了 PrORT 联合手术与单纯手术治疗对 OS 的疗效。采用倾向评分匹配（PSM）平衡接受（n=239）和未接受（n=1151）PrORT 的患者的基线特征。使用 Kaplan-Meier 法比较两组患者的 OS，并使用对数秩检验比较 PSM 前后两组患者的 OS，并对鳞癌（SCC）和腺癌亚组患者进行分析。
在未进行 PSM 的全组分析中，PrORT 组的中位 OS 优于单纯手术组（44.0[34.4-56.6] vs 39.0[34.5-43.5]个月）。OS 存在显著差异[风险比（HR）：0.819；95%置信区间（CI）：0.677-0.991；P=0.029]。然而，PSM 后两组患者的 OS 无统计学差异（HR：0.856；95%CI：0.654-1.122；P=0.260）。在未进行 PSM 的 SCC 亚组分析中，与未接受 PrORT 的患者相比，接受 PrORT 的患者中位 OS 明显更长（52.0[40.0-NA] vs 27.0[22.0-32.0]个月；HR：0.591，95%CI：0.442-0.792，P=0.000），且 PSM 后 OS 存在差异（P=0.043）。然而，在腺癌组中，OS 在匹配前后均无显著差异（P=0.827 和 P=0.801）。
PrORT 显示对 N2 期肺 SCC 患者的 OS 有益；然而，需要进一步的前瞻性随机临床试验来证实这一发现。
