Yao Jinquan, Geng Yuxin, Xu Junhao, Zou Bingwen, Teng Feifei
Department of Radiation Oncology, Shandong Provincial Key Laboratory of Radiation Oncology, Shandong Cancer Hospital and Institute, Shandong First Medical University, Shandong Academy of Medical Sciences, Jinan, Shandong, 250117, China.
Department of Outpatient Chemotherapy, Harbin Medical University Cancer Hospital, Harbin, 150000, China.
BMC Cancer. 2025 May 12;25(1):858. doi: 10.1186/s12885-025-14255-0.
The role of postoperative radiotherapy (PORT) for patients with completely resected stage III-pN2 non-small-cell lung cancer (NSCLC) remains controversial. PORT is not routinely recommended for patients with completely resected stage III-pN2 NSCLC. Therefore, identifying the population that could benefit from PORT is urgently needed.
We retrospectively enrolled 251 patients with completely resected stage III-pN2 NSCLC at our institution between 2018 and 2023. The Kaplan-Meier curves and log-rank tests were used to analyze disease-free survival (DFS) and overall survival (OS). Risk factors were identified using univariate and multivariate Cox regression analyses. The cumulative incidence rates of locoregional recurrence (LRR) were calculated via competing risk analyses and compared using the Gray test.
A total of 251 patients were enrolled in the study, with the median follow-up of 24.9 months. Among overall patients, 61 patients underwent PORT, and 190 patients did not. Although patients in the PORT group exhibited a trend toward longer DFS, the difference was not statistically significant (median DFS: 39.1 vs. 35.5 months; HR 0.58, 95% CI 0.35-0.97; p = 0.072). Subgroup analyses revealed that PORT significantly prolonged DFS both in EGFR wild-type patients (median DFS: 35.3 vs. 18.3 months; HR 0.33, 95% CI 0.17-0.62; p = 0.002) and in PD-L1 positive patients (median DFS: 35.3 vs.16.4 months; HR 0.35, 95% CI 0.16-0.74; p = 0.029). In contrast, no significant DFS or OS benefits were observed in EGFR mutant patients or PD-L1 negative patients. Furthermore, PORT was associated with the significantly lower risk of LRR in overall patients (HR 0.39, 95% CI 0.16-0.97; p = 0.043), EGFR wild-type patients (HR 0.25, 95% CI 0.09-0.68; p = 0.007), and PD-L1 positive patients (HR 0.15, 95% CI 0.03-0.70; p = 0.016). PORT did not confer a locoregional control benefit in EGFR mutant patients (HR 0.58, 95% CI 0.07-4.58; p = 0.61) or PD-L1 negative patients (HR 1.02, 95% CI 0.27-3.82; p = 0.98).
For patients with completely resected stage III-pN2 NSCLC, PORT significantly improves DFS and reduces the risk of LRR in EGFR wild-type patients or PD-L1 positive patients. The EGFR and PD-L1 status may serve as biomarkers to identify the population that could benefit from PORT.
术后放疗（PORT）对于完全切除的Ⅲ期 - pN2非小细胞肺癌（NSCLC）患者的作用仍存在争议。对于完全切除的Ⅲ期 - pN2 NSCLC患者，通常不建议进行PORT。因此，迫切需要确定能从PORT中获益的人群。
我们回顾性纳入了2018年至2023年间在我院完全切除的Ⅲ期 - pN2 NSCLC患者251例。采用Kaplan-Meier曲线和对数秩检验分析无病生存期（DFS）和总生存期（OS）。通过单因素和多因素Cox回归分析确定危险因素。通过竞争风险分析计算局部区域复发（LRR）的累积发病率，并使用Gray检验进行比较。
共纳入251例患者，中位随访时间为24.9个月。在所有患者中，61例接受了PORT，190例未接受。虽然PORT组患者的DFS有延长趋势，但差异无统计学意义（中位DFS：39.1个月对35.5个月；HR 0.58，95%CI 0.35 - 0.97；p = 0.072）。亚组分析显示，PORT在EGFR野生型患者（中位DFS：35.3个月对18.3个月；HR 0.33，95%CI 0.17 - 0.62；p = 0.002）和PD-L1阳性患者（中位DFS：35.3个月对16.4个月；HR 0.35，95%CI 0.16 - 0.74；p = 0.029）中均显著延长了DFS。相比之下，在EGFR突变患者或PD-L1阴性患者中未观察到显著的DFS或OS获益。此外，PORT在总体患者（HR 0.39，95%CI 0.16 - 0.97；p = 0.043）、EGFR野生型患者（HR 0.25，95%CI 0.09 - 0.68；p = 0.007）和PD-L1阳性患者（HR 0.15，95%CI 0.03 - 0.70；p = 0.016）中与显著较低的LRR风险相关。PORT在EGFR突变患者（HR 0.58，95%CI 0.07 - 4.58；p = 0.61）或PD-L1阴性患者（HR 1.02，95%CI 0.27 - 3.82；p = 0.98）中未带来局部区域控制获益。
对于完全切除的Ⅲ期 - pN2 NSCLC患者，PORT可显著改善EGFR野生型患者或PD-L1阳性患者的DFS并降低LRR风险。EGFR和PD-L1状态可作为生物标志物来识别能从PORT中获益的人群。
