The influence of postoperative lymph node radiation therapy on overall survival of patients with stage III melanoma, a National Cancer Database analysis
The influence of postoperative lymph node radiation therapy on overall survival of patients with stage III melanoma, a National Cancer Database analysis
复制标题
DOI：
10.1097/cmr.0000000000000292
复制
发表时间：
2016-12-01
影响因子：
2.2
通讯作者：
Khan, Mohammad K.
中科院分区：
文献类型：
--
作者：
Danish, Hasan H.;Patel, Kirtesh R.;Khan, Mohammad K.
最近，TROG 02.01结果显示，在伴有淋巴结转移的III期黑色素瘤患者中，淋巴结清扫后对淋巴结盆的辅助放疗改善了淋巴结区域复发，但没有总生存期（OS）获益。然而，该试验的设计和把握度均不足以检测OS差异。在本研究中，我们分析了国家癌症数据库（NCDB）中患有III期黑色素瘤并伴有病理受累淋巴结的患者，并比较了辅助放疗和无放疗队列的生存结局。入选标准如下：年龄至少18岁; 2003-2011年诊断;局部淋巴结手术;病理累及淋巴结;美国癌症联合委员会分期（IIIA-C）。我们使用倾向评分匹配分析来比较具有相似基线人口统计学、临床和病理学特征的接受辅助放疗和未接受辅助放疗的患者的OS。总体而言，分析了912例患者，诊断时平均年龄为54.4岁，中位随访时间为5.5年。在该队列中，IIIA、IIIB和IIIC期患者的5年OS分别为69.0%、51.1%和30.6%。在倾向评分调整的多变量分析中，我们发现辅助放疗对OS没有统计学显著影响（风险比：1.09，95%置信区间：0.75-1.58，P=0.640）。此外，年龄大于60岁、淋巴结数量、病理分期增加和缺乏免疫治疗与OS恶化相关。在这项NCDB分析中，我们发现淋巴结阳性III期黑色素瘤患者的辅助放疗并未改善OS。这与TROG 02.01一致;然而，可能存在NCDB未考虑的患者选择偏倚。(C)2016年威科医疗集团All rights reserved.
Recently, TROG 02.01 results showed that in stage III melanoma patients with nodal metastasis, adjuvant radiation to lymph node basin after nodal dissection improves lymph node field relapse without an overall survival (OS) benefit. However, this trial was neither designed nor powered to detect an OS difference. In the present study, we analyzed patients in the National Cancer Database (NCDB) with stage III melanoma with pathologically involved nodes and compared survival outcomes of adjuvant radiation and no-radiation cohorts. Inclusion criteria were as follows: age at least 18 years; diagnosed 2003-2011; surgery to regional lymph nodes; pathologically involved lymph nodes; and American Joint Committee on Cancer stage (IIIA-C). We used propensity score matching analysis to compare the OS of patients with similar baseline demographic, clinical, and pathologic characteristics who received adjuvant radiation and no adjuvant radiation. Overall, 912 patients were analyzed with an average age at diagnosis of 54.4 years and a median follow-up time of 5.5 years. In this cohort, the 5-year OS was 69.0, 51.1, and 30.6% for stage IIIA, IIIB, and IIIC, respectively. On propensity score-adjusted multivariate analysis, we found that adjuvant radiation had no statistically significant impact on OS (hazard ratio: 1.09, 95% confidence interval: 0.75-1.58, P=0.640). Furthermore, age older than 60 years, number of nodes, increasing pathologic stage, and absence of immunotherapy correlated with worse OS. In this NCDB analysis, we found that the adjuvant radiotherapy for node-positive, stage III melanoma patients did not improve OS. This is consistent with TROG 02.01; however, there may be patient selection bias not accounted for by the NCDB. (C) 2016 Wolters Kluwer Health, Inc. All rights reserved.