Duan Richard, Kwan Michelle, Kordon Avram, Hu Carolyn J, Vanjani Nisheka, Liu Yingzhe, Thomas Tarita O, Gupta Divya, Patel Jyoti, Yadav Poonam, Abazeed Mohamed E, Sun Zequn, Gharzai Laila A
Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA.
Department of Radiation Oncology, Northwestern University, Chicago, Illinois, USA.
Thorac Cancer. 2025 Feb;16(3):e70009. doi: 10.1111/1759-7714.70009.
Stage III non-small cell lung cancer (NSCLC) treatment remains challenging, with a multitude of treatment options available. We assessed Stage IIIA NSCLC outcomes by treatment received.
We performed a single-institution retrospective review of NSCLC patients with Stage IIIA disease treated January 01, 2010-March 01, 2022. Demographics, treatments, outcomes, and failure patterns were collected. Progression-free survival (PFS) and overall survival (OS) were assessed using Kaplan-Meier analysis. Failure patterns were assessed for differences using chi-square analysis.
Of 270 Stage III NSCLC patients, 134 had Stage IIIA disease with a median follow-up of 29.9 months and a median age of 66 years (IQR 60-75). 66 (49.3%) patients were male, and 105 (78.4%) were current/former smokers (with 30 median pack-years). Patients were treated with definitive radiation with/without chemotherapy (CRT; n = 77, 57.5%), surgery with neoadjuvant chemotherapy and/or radiation (Neoadj; n = 42, 31.3%), and surgery without neoadjuvant therapy (Surg; n = 15, 11.2%). Median PFS was 25.4 months (95% CI 12.5-42.6) for CRT, 22.6 months (95% CI 12.2-44.4) for Neoadj, and 22.8 months (95% CI 5.2-NA) for Surg with no significant intergroup difference (p = 0.99). Median OS was 57.0 months (95% CI 37.4-77.5) for CRT, 51.5 months (95% CI 36.7-65.5) for Neoadj, and 35.3 months (95% CI 16.8-NR) for Surg with no significant intergroup difference (p = 0.99).
In this single institution retrospective study, we find no significant differences in PFS, OS, and failure patterns between patients with Stage IIIA NSCLC treated with definitive (chemo)radiation and surgery with or without neoadjuvant therapy. Further work in the immunotherapy era is needed.
III期非小细胞肺癌（NSCLC）的治疗仍然具有挑战性，有多种治疗选择可供选择。我们根据接受的治疗评估了IIIA期NSCLC的治疗结果。
我们对2010年1月1日至2022年3月1日期间接受治疗的IIIA期疾病的NSCLC患者进行了单机构回顾性研究。收集了人口统计学、治疗、结果和失败模式。使用Kaplan-Meier分析评估无进展生存期（PFS）和总生存期（OS）。使用卡方分析评估失败模式的差异。
在270例III期NSCLC患者中，134例患有IIIA期疾病，中位随访时间为29.9个月，中位年龄为66岁（IQR 60-75）。66例（49.3%）患者为男性，105例（78.4%）为当前/既往吸烟者（中位吸烟包年数为30）。患者接受了有/无化疗的根治性放疗（CRT；n = 77，57.5%）、新辅助化疗和/或放疗的手术（新辅助；n = 42，31.3%）以及无新辅助治疗的手术（手术；n = 15，11.2%）。CRT的中位PFS为25.4个月（95% CI 12.5-42.6），新辅助治疗为22.6个月（95% CI 12.2-44.4），手术为22.8个月（95% CI 5.2-NA），组间无显著差异（p = 0.99）。CRT的中位OS为57.0个月（95% CI 37.4-77.5），新辅助治疗为51.5个月（95% CI 36.7-65.5），手术为35.3个月（95% CI 16.8-NR），组间无显著差异（p = 0.99）。
在这项单机构回顾性研究中，我们发现接受根治性（化疗）放疗和有或无新辅助治疗的手术的IIIA期NSCLC患者在PFS、OS和失败模式方面没有显著差异。免疫治疗时代需要进一步的研究。
