手术治疗 IIIA-N2 期非小细胞肺癌患者的高危特征和术后放疗对生存的影响。
The high-risk features and effect of postoperative radiotherapy on survival for patients with surgically treated stage IIIA-N2 non-small cell lung cancer.
机构信息
Department of Thoracic Surgery, The Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an, 710004, Shaanxi, China.
Department of Thoracic Surgery, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, 325000, Zhejiang, China.
出版信息
World J Surg Oncol. 2023 Aug 4;21(1):238. doi: 10.1186/s12957-023-03093-8.
OBJECTIVES
Although postoperative radiotherapy (PORT) could reduce the incidence of local recurrence in patients with IIIA-N2 non-small cell lung cancer (NSCLC), the role of PORT on survival in patients with surgically treated stage IIIA-N2 NSCLC remains controversial. Therefore, this study was designed to evaluate the effect of PORT on survival for patients with surgically treated stage IIIA-N2 NSCLC.
MATERIALS AND METHODS
This study population was chosen from the Surveillance, Epidemiology, and End Results database. The Cox proportional hazards regression analysis was used to determine significant contributors to overall survival (OS) and cancer special survival (CSS) outcomes. To balance baseline characteristics between the non-PORT group and PORT group, propensity score matching (PSM) with 1:1 propensity nearest-neighbor match by 0.001 matching tolerance was conducted by R software. Furthermore, a Kaplan-Meier curve was used to visualize the OS and CSS between the PORT group and non-PORT group survival probability.
RESULTS
Of all evaluated cases, 4511 with IIIA-N2 NSCLC were eligible for inclusion, of which 1920 were enrolled into the PORT group. On univariate analysis and multivariate analysis, sex, age, year of diagnosis, race, histologic type, T stage, PORT, use of chemotherapy, and positive regional nodes were significantly associated with OS and CSS in IIIA-N2 NSCLC (P < 0.05). However, PORT was not significantly associated with OS (univariate HR = 0.92, 95%CI 0.85-0.99, P = 0.02; multivariate HR = 1.01, 95%CI 0.93-1.08, P = 0.91) and CSS (univariate HR = 0.92, 95%CI 0.85-1.01, P = 0.06; multivariate HR = 1.103 95%CI 0.94-1.12, P = 0.56) in IIIA-N2 NSCLC. Meanwhile, after PSM, neither OS nor CSS did differ significantly between the non-PORT group and PORT group (OS HR = 1.08, 95%CI 0.98-1.19, P = 0.12; CSS HR = 1.10, 95%CI 0.99-1.23, P = 0.07).
CONCLUSION
PORT did not contribute to a survival benefit in patients with surgically treated stage IIIA-N2 NSCLC.
目的
尽管术后放疗（PORT）可降低 IIIA-N2 期非小细胞肺癌（NSCLC）患者局部复发的发生率，但 PORT 对手术治疗的 IIIA-N2 期 NSCLC 患者生存的影响仍存在争议。因此，本研究旨在评估 PORT 对手术治疗的 IIIA-N2 期 NSCLC 患者生存的影响。
材料和方法
本研究人群选自监测、流行病学和最终结果数据库。采用 Cox 比例风险回归分析确定总生存（OS）和癌症特异性生存（CSS）结果的显著影响因素。为了在非 PORT 组和 PORT 组之间平衡基线特征，使用 R 软件进行了倾向评分匹配（PSM），采用 1:1 倾向最近邻匹配，匹配容差为 0.001。此外，使用 Kaplan-Meier 曲线可视化 PORT 组和非 PORT 组的 OS 和 CSS 生存概率。
结果
在所有评估病例中，4511 例 IIIA-N2 NSCLC 患者符合纳入标准，其中 1920 例被纳入 PORT 组。单因素和多因素分析显示，性别、年龄、诊断年份、种族、组织学类型、T 分期、PORT、化疗使用和阳性区域淋巴结与 IIIA-N2 NSCLC 的 OS 和 CSS 显著相关（P<0.05）。然而，PORT 与 OS （单因素 HR=0.92，95%CI 0.85-0.99，P=0.02；多因素 HR=1.01，95%CI 0.93-1.08，P=0.91）和 CSS （单因素 HR=0.92，95%CI 0.85-1.01，P=0.06；多因素 HR=1.103，95%CI 0.94-1.12，P=0.56）均无显著相关性。同时，经过 PSM 后，非 PORT 组和 PORT 组的 OS 和 CSS 差异均无统计学意义（OS HR=1.08，95%CI 0.98-1.19，P=0.12；CSS HR=1.10，95%CI 0.99-1.23，P=0.07）。
结论
PORT 并未为手术治疗的 IIIA-N2 期 NSCLC 患者带来生存获益。
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