Chen Zu Yi, Liang Huan Wei, Liu Yang, Huang Wei, Pan Xin Bin
Department of Interventional Radiology, Guangxi Medical University Cancer Hospital, Nanning, Guangxi 530021, China.
Department of Radiation Oncology, Guangxi Medical University Cancer Hospital, Nanning, Guangxi 530021, China.
World J Oncol. 2024 Apr;15(2):309-318. doi: 10.14740/wjon1832. Epub 2024 Mar 21.
The aim of the study was to assess the effectiveness of postoperative radiotherapy in high-risk patients with stage pIIIA-N2 non-small cell lung cancer (NSCLC) following complete resection and adjuvant chemotherapy.
Data from NSCLC patients within the Surveillance, Epidemiology, and End Results (SEER) database were analyzed. The study examined the association between lymph node ratio (LNR) and both cancer-specific survival (CSS) and overall survival (OS) using restricted cubic spline curves. Patients were categorized into high- and low-risk groups based on established LNR cut-off values, and survival outcomes were compared between those receiving postoperative radiotherapy and those who did not within the high-risk group.
The study included 1,690 patients. An LNR threshold of 0.29 was identified for both CSS and OS. Patients with an LNR ≥ 0.29 demonstrated significantly worse CSS (hazard ratio (HR) = 1.56, 95% confidence interval (CI): 1.37 - 1.78; P < 0.001) and OS (HR = 1.44, 95% CI: 1.28 - 1.62; P < 0.001) compared to those with an LNR < 0.29. In the high-risk group (LNR ≥ 0.29), postoperative radiotherapy did not significantly affect CSS (HR = 0.98, 95% CI: 0.82 - 1.17; P = 0.809) or OS (HR = 0.95, 95% CI: 0.81 - 1.11; P = 0.533).
LNR is a significant prognostic factor in patients with stage pIIIA-N2 NSCLC post complete resection and adjuvant chemotherapy. A higher LNR (≥ 0.29) is associated with poorer CSS and OS. However, postoperative radiotherapy does not confer survival benefits in these high-risk patients. Our findings suggest that postoperative radiotherapy should not be routinely performed in this subgroup. Further research is required to explore effective treatment strategies for these patients.
本研究旨在评估术后放疗对完全切除并接受辅助化疗的pIIIA-N2期高危非小细胞肺癌（NSCLC）患者的有效性。
分析了监测、流行病学和最终结果（SEER）数据库中NSCLC患者的数据。本研究使用受限立方样条曲线检验淋巴结比率（LNR）与癌症特异性生存（CSS）和总生存（OS）之间的关联。根据既定的LNR临界值将患者分为高危组和低危组，并比较高危组中接受术后放疗和未接受术后放疗患者的生存结局。
本研究纳入了1690例患者。确定CSS和OS的LNR阈值均为0.29。与LNR<0.29的患者相比，LNR≥0.29的患者CSS（风险比（HR）=1.56，95%置信区间（CI）：1.37 - 1.78；P<0.001）和OS（HR = 1.44，95%CI：1.28 - 1.62；P<0.001）显著更差。在高危组（LNR≥0.29）中，术后放疗对CSS（HR = 0.98，95%CI：0.82 - 1.17；P = 0.809）或OS（HR = 0.95，95%CI：0.81 - 1.11；P = 0.533）无显著影响。
LNR是完全切除并接受辅助化疗的pIIIA-N2期NSCLC患者的重要预后因素。较高的LNR（≥0.29）与较差的CSS和OS相关。然而，术后放疗对这些高危患者无生存益处。我们的研究结果表明，该亚组患者不应常规进行术后放疗。需要进一步研究以探索这些患者的有效治疗策略。
