National Institute of Cancer Research, National Health Research Institutes, Miaoli 350, Taiwan.
Department of Radiation Oncology, Chang Gung Memorial Hospital, Taoyuan 333, Taiwan; Graduate Institute of Clinical Medical Sciences. College of Medicine, Chang Gung University, Taoyuan 333, Taiwan.
Lung Cancer. 2023 Oct;184:107357. doi: 10.1016/j.lungcan.2023.107357. Epub 2023 Aug 29.
BACKGROUND: Tumour differentiation is an important index for adjuvant therapy in many cancers; however, non-small cell lung cancer (NSCLC) is an exception. Furthermore, postoperative radiotherapy (PORT) is controversial in patients with NSCLC with N0-1 and N2 disease. We aimed to evaluate the impact of tumour-related factors on overall survival (OS), cancer-specific survival (CSS), and distant control (DC) in patients with completely resected stage IIIA NSCLC. MATERIALS AND METHODS: Patients with stage IIIA non-metastatic NSCLC who underwent complete resection and adjuvant chemotherapy were identified from the Taiwan Cancer Registry (January 2007-December 2017). Logistic regression analysis was performed to determine the factors associated with PORT. Survival and relapse outcomes were compared using log-rank tests and Cox regression analysis. Sensitivity analysis was performed using propensity score-matched pairs. RESULTS: In total, 1,897 patients were included and stratified according to PORT use (PORT vs. non-PORT). After adjusting for covariates, PORT was not found to be associated with improved survival outcomes. In patients with poorly differentiated tumours and N2 disease, absolute benefits for OS (adjusted hazard ratio [aHR] 0.76), CSS (aHR 0.80), and DC (aHR 0.74) were observed. Multivariable hazard models of propensity score-matched pN2 disease and poorly differentiated tumour subgroups also showed significant survival benefit with PORT treatment. CONCLUSIONS: Patients with poorly differentiated tumours and receiving PORT for pN2 disease showed a lower risk of distant recurrence and more favourable survival outcomes in stage IIIA NSCLC with R0 resection.
背景:肿瘤分化是许多癌症辅助治疗的一个重要指标;然而,非小细胞肺癌(NSCLC)是一个例外。此外,对于 N0-1 和 N2 期 NSCLC 患者,术后放疗(PORT)存在争议。我们旨在评估肿瘤相关因素对完全切除的 IIIA 期 NSCLC 患者总生存(OS)、癌症特异性生存(CSS)和远处控制(DC)的影响。
材料与方法:从台湾癌症登记处(2007 年 1 月-2017 年 12 月)中确定接受完全切除和辅助化疗的 IIIA 期非转移性 NSCLC 患者。采用逻辑回归分析确定与 PORT 相关的因素。使用对数秩检验和 Cox 回归分析比较生存和复发结局。采用倾向评分匹配对进行敏感性分析。
结果:共纳入 1897 例患者,并根据 PORT 使用情况(PORT 组与非 PORT 组)进行分层。调整协变量后,PORT 并未改善生存结局。在分化差的肿瘤和 N2 期患者中,OS(调整后的危险比[aHR]0.76)、CSS(aHR 0.80)和 DC(aHR 0.74)的绝对获益。pN2 疾病和低分化肿瘤亚组的多变量风险模型也显示 PORT 治疗具有显著的生存获益。
结论:在 R0 切除的 IIIA 期 NSCLC 中,分化差的肿瘤患者且接受 PORT 治疗的 pN2 疾病患者远处复发风险较低,生存结局更有利。