Department of Cardiothoracic Surgery, Xiangtan Central Hospital, Xiangtan, Hunan, China.
School of Medical Equipment and Management, Xiangtan Medicine and Health Vocational College, Xiangtan, Hunan, China.
Medicine (Baltimore). 2023 Jun 16;102(24):e34015. doi: 10.1097/MD.0000000000034015.
Postoperative radiotherapy (PORT) is commonly used to treat patients with resected stage III non-small cell lung cancer (NSCLC), but its effectiveness remains uncertain. This retrospective cohort study aimed to investigate the impact of PORT on overall survival (OS) and evaluate its heterogeneity among subgroups of patients.
A total of 6305 patients with resected stage III NSCLC were included in this study from the Surveillance, Epidemiology, and End Results (SEER) database. Propensity score matching was conducted to balance baseline characteristics between the patients who received PORT and those who did not. OS was used as the primary outcome. Subgroup analysis was performed to identify which patient subgroups might benefit more from PORT.
Overall, no significant difference was observed in OS between the 2 groups with or without propensity score matching. However, subgroup analysis demonstrated that PORT improved OS in patients with certain characteristics, including stage IIIA/N2, stage IIIB, squamous cell carcinoma, tumor grade III-IV, or lymph node ratio (LNR) > 1/3. Multivariate analysis showed that several variables were associated with adverse prognostic factors for OS, such as marital status (others), race (white), male gender, squamous cell carcinoma, elderly age, advanced stage, poor histological differentiation grade, high LNR, and not receiving chemotherapy.
In patients with resected stage III NSCLC, PORT may not be beneficial for all patients. However, it may improve survival time in certain patient subgroups, such as those with stage IIIA/N2, stage IIIB, squamous cell carcinoma, tumor grade III to IV, or LNR > 1/3. These findings provide important information for clinical decision-making and future research regarding the use of PORT in patients with resected stage III NSCLC.
术后放疗（PORT）常用于治疗 III 期非小细胞肺癌（NSCLC）患者，但疗效仍不确定。本回顾性队列研究旨在探讨 PORT 对总生存期（OS）的影响，并评估其在患者亚组中的异质性。
从监测、流行病学和最终结果（SEER）数据库中纳入 6305 例接受 III 期 NSCLC 根治性手术的患者。采用倾向评分匹配法平衡 PORT 组和未接受 PORT 组患者的基线特征。OS 为主要结局。进行亚组分析以确定哪些患者亚组可能从 PORT 中获益更多。
总体而言，倾向评分匹配前后两组 OS 无显著差异。但亚组分析显示，PORT 改善了某些特征患者的 OS，包括 IIIA/N2 期、IIIB 期、鳞状细胞癌、肿瘤分级 III-IV 级或淋巴结比值（LNR）>1/3。多变量分析显示，婚姻状况（其他）、种族（白种人）、男性、鳞状细胞癌、高龄、晚期、组织学分化程度差、高 LNR 和未接受化疗等多个变量与 OS 的不良预后因素相关。
在接受 III 期 NSCLC 根治性手术的患者中，PORT 并非对所有患者都有益。然而，它可能会改善某些患者亚组的生存时间，如 IIIA/N2 期、IIIB 期、鳞状细胞癌、肿瘤分级 III-IV 级或 LNR>1/3。这些发现为临床决策和未来研究提供了重要信息，有助于确定 PORT 在接受 III 期 NSCLC 根治性手术的患者中的应用。
