The lymph node status and histologic subtypes influenced the effect of postoperative radiotherapy on patients with N2 positive IIIA non-small cell lung cancer
The lymph node status and histologic subtypes influenced the effect of postoperative radiotherapy on patients with N2 positive IIIA non-small cell lung cancer
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淋巴结状态和组织学亚型对N2阳性IIIA型非小细胞肺癌患者术后放疗效果的影响
DOI：
10.1002/jso.25308
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发表时间：
2019-03-01
影响因子：
2.5
通讯作者：
Sun, Yihua
中科院分区：
文献类型：
--
作者：
Yuan, Chongze;Tao, Xiaoting;Sun, Yihua
背景与目的探讨术后放射治疗（PORT）在IIIA-N2非小细胞肺癌（NSCLC）患者及PORT获益亚组中的作用。方法收集576例经手术切除的IIIA-N2非小细胞肺癌患者。采用倾向评分匹配（PSM）方法平衡两组患者的特征。比较PORT和非PORT患者的总生存期（OS）和无复发生存期（RFS）。结果在多因素分析中，OS的改善与年龄较小、单N2站受累、淋巴结阳性较少和化疗相关。PSM后，121例PROT患者和242例非PORT患者匹配。PORT与患者OS（P = 0.735）或RFS（P = 0.483）的改善无关。对于术后化疗（POCT）的患者，PORT可提高单N2站介入患者的OS（HR：0.572，95%CI：0.312 ~ 1.05，P = 0.040）。乳头状腺癌患者也从PORT中获益，OS增加（HR：0.350，95%CI：0.126至0.972，P = 0.033）。结论对于完全切除的IIIA-N2 NSCLC患者，纵隔淋巴结转移和组织学亚型可能影响PORT的疗效。单一N2站受累和乳头状占优势亚型是PORT获益的预测因素。
Background and Objective To investigate the role of postoperative radiotherapy (PORT) in IIIA-N2 non-small cell lung cancer (NSCLC) patients and subgroups which derived benefit from PORT. Methods A total of 576 patients with pathological IIIA-N2 NSCLC, who underwent complete resection, were identified. Propensity score matching (PSM) methods were used to balance the patients' characteristics between two groups. Overall survival (OS) and relapse-free survival (RFS) were compared between PORT and non-PORT patients. Results On multivariable analysis, improved OS remained correlated with younger age, single N2 station involvement, less positive lymph nodes, and chemotherapy. After PSM, 121 PROT patients and 242 non-PORT patients were matched. PORT was not associated improved patients' OS (P = 0.735) or RFS (P = 0.483). For patients who underwent postoperative chemotherapy (POCT), PORT could improve OS in single N2 station involved patients (HR: 0.572, 95%CI: 0.312 to 1.05, P = 0.040). Patients with papillary predominant adenocarcinoma also benefited from PORT with an increase in OS (HR: 0.350, 95%CI: 0.126 to 0.972, P = 0.033). Conclusions For patients with completely resected IIIA-N2 NSCLC, mediastinal lymph node metastasis and histologic subtypes could influence the effect of PORT. Single N2 station involvement and papillary predominant subtype were predictors of benefit from PORT.