| Objective: To compare the clinical efficacy and side effects of concurrent chemoradiotherapy and chemotherapy alone in the treatment of stage ?A-N2 non-small cell lung cancer(NSCLC)after radical operation,and to explore the factors influencing the prognosis.Methods: From January 2007 to December 2012 during the period of patients with stage ?A-N2 NSCLC undergoing radical surgery in Sichuan cancer hospital,there were 136 cases meet the inclusion criteria.Of which,51 cases received concurrent chemoradiation and 85 cases received chemotherapy alone.Paired with Propensity matched scoring method(PSM),there were 98 cases(49 cases /group)after matching.Chemotherapy alone group is based on platinum-based combination chemotherapy,the number of cycles of chemotherapy was 2 to 6cycles.The concurrent radio chemotherapy group received image-guided radiation therapy(IGRT)with an average dose of 50 Gy(range,46 Gy-52 Gy),giving 1-2 cycles of chemotherapy in radiotherapy synchronization,and supplemented to 2-6 cycles after the end of radiotherapy.The primary end points were overall survival(OS),Progression-free survival(PFS),local recurrence free survival(LRFS),and Distant recurrence free survival(DRFS).Secondary endpoints were side effects of chemoradiation,includingmyelosuppression,radiation pneumonitis,radiation esophagitis and so on.Statistical analysis was carried out with SPSS 19 statistical software,and X2 test was used to compare the difference between clinical and pathological features.OS,PFS,LRFS,DRFS were calculated by Kaplan-Meier method,single factor analysis was analyzed with log-rank test,multifactor analysis was carried out by Cox model,and paired propensity score matching(PSM)was used for paired analysis.P <0.05 indicates a statistically significant difference.Results: The study was followed up to May 2017.There was no significant difference in the general clinical data between the two groups before matching.The median survival time of all the patients was 31 months.The overall survival rates at the first year,the third year and the fifth year were 77.9%,43.4% and 19.9% respectively.The median survival time was 38 months vs 27 months in the concurrent chemoradiation group and the chemotherapy alone group.The 1,3,5-year survival rates were 88.0% vs 72.1%,54.0% vs 39.5%,and 27.9% vs 14.7%.Difference was statistically significant(P = 0.016).The median local control time was 53 months vs 33 months(P = 0.014)in the concurrent chemoradiation group and chemotherapy-only group.Difference was statistically significant(P = 0.014).There was no significant difference in the median distant recurrence-free survival between the two groups at 29 months vs 27 months(P = 0.609).The median progression-free survival time was 19 months vs.12 months in the two group.Difference was statistically significant(P = 0.025).Single factor analysis showed that the number ofpostoperative lymph node station of metastasis,whether or not N1 node involvement,postoperative T pathology staging as well as whether or not radiotherapy are important prognostic factors of NSCLC.Multivariate analysis showed that the the number of postoperative lymph node station of metastasis,whether or not N1 node involvement,postoperative T pathology staging as well as whether or not radiotherapy are independent prognostic factors of survival time.Number of postoperative lymph node station of metastasis,whether or not N1 node involvement and whether or not radiotherapy are independent influencing factors of progression-free survival.Number of postoperative lymph node station of metastasis and radiotherapy are independent influencing factors of local recurrence-free survival.Paired according to the number of postoperative lymph node station of metastasis,whether or not N1 node involvement,postoperative T pathology staging and whether or not radiotherapy,there are a total of 98 cases after matching(49cases / group).There was no significant difference in the general clinical data between the two groups after matching.The median survival time was 39 months vs.26 months in the concurrent chemoradiation group and chemotherapy-only after matching.The 1,3,5-year survival rates of the two groups were 91.7% vs 81.3%,56.3% vs 33.3% and 29.1% vs 17.5%respectively.Difference was statistically significant(P = 0.033).The median local control time in the two groups was 53 months vs 38months(P = 0.038),with significant differences.There was no significant difference in the mediandistant recurrence-free survival between the two groups at 29 months vs 27months(P = 0.544).The median progression-free survival time was 20 months vs 12 months in the two groups.Difference was statistically significant(P =0.036).The toxic and side effects of the whole group include bone marrow suppression,radiation pneumonitis,radiation esophagitis and so on.The incidences of ?-IV leukopenia in the concurrent chemoradiotherapy group and the chemotherapy alone group were 25.6% and 20.4%,respectively,with no significant difference(P = 0.098).The incidences of ?-IV ° digestive tract reactions in the two groups were 22.4% and 17.2% respectively,with no significant difference(P = 0.243).The incidence of radiation esophagitis was10.2% and acute radiation pneumonitis was 8.1% in the concurrent chemoradiotherapy group,and both are between I and ? level.The main causes of failure in the treatment of stage ?A-N2 NSCLC after radical resection were distant metastasis.There are a total of 39 cases of distant metastasis exists,accounting for 39.7%,of which 20 cases were treated with concurrent chemoradiotherapy accounting for 39.7%,while 19 cases were treated with chemotherapy alone accounting for 38.7%(P> 0.05).Conclusion:Compared with chemotherapy alone,concurrent chemoradio-therapy using image guided radiation therapy(IGRT)improves the overall survival,diseasefree survival and local control rate of patients with stage ?A-N2 NSCLC after radical operation.But there was no obvious benefit in the distant recurrencefree survival.the number of postoperative lymph node station of metastasis,whether or not N1 node involvement,postoperative T pathology staging as well as whether or not radiotherapy are independent prognostic factors of survival time.Number of postoperative lymph node station of metastasis,whether or not N1 node involvement and whether or not radiotherapy are independent influencing factors of progression-free survival.Number of postoperative lymph node station of metastasis and whether or not radiotherapy are independent influencing factors of local recurrence-free survival.The hematologic toxicity and the incidence of gastrointestinal reaction in the concurrent chemoradiotherapy group were higher than that in the chemotherapy alone group,but there was no significant difference.The radiotherapy used in this study was IGRT.The incidence of radiation pneumonitis and radiation esophagitis was low,and patients were well tolerated. |
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