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The Role Of Postoperative Radiotherapy In The Survival Of Patients With Stage ⅢA-N2 Non-small Cell Lung Cancer

Posted on:2022-04-18Degree:MasterType:Thesis
Country:ChinaCandidate:J ZhangFull Text:PDF
GTID:2504306314458204Subject:Oncology
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Background:Patients with ⅢA-N2 non-small cell lung cancer(NSCLC)have high heterogeneity.For patients with resectable ⅢA-N2 NSCLC,surgical resection is preferred.However,mediastinal or subcarinal lymph nodes metastasis increases the probability local recurrence and distant metastasis after surgery.ⅢA-N2 NSCLC patients have a poor prognosis with a 5-year overall survival(OS)rate of only 19-24%.Therefore,adjuvant therapy should be performed after surgery.The current standard adjuvant therapy is postoperative chemotherapy(POCT).As a direct vehicle for local treatment,postoperative radiotherapy(PORT)is an important component of adjuvant therapy and has been considered to reduce the risk of local recurrence in stage ⅢA-N2 NSCLC.However,whether this local disease-free benefit translates into an OS benefit is controversial.Therefore,the aim of our study was to evaluate the role of PORT on survival in stage ⅢA-N2 NSCLC.Methods:In Part Ⅰ,we collected clinical and follow-up data from 2010-2015 from the Surveillance,Epidemiology and End Results(SEER)database for patients with stageⅢA-N2 NSCLC treated with POCT.Patients were divided into postoperative chemoradiotherapy(POCRT)and POCT groups.Pearson’s chi-square test was used for baseline comparisons.Propensity score matching(PSM)analysis was used for case matching and baseline correction.Univariate and multivariate Cox proportional hazards regression models were used to screen for independent prognostic factors that had an impact on prognosis.Kaplan-Meier survival curves and log-rank tests were used to assess the effect of PORT on OS and cancer specific survival(CSS).For further validation,clinical and follow-up data of stage ⅢA-N2 NSCLC patients at Shandong Cancer Hospital were collected in the second part.Lymph node status related variables and disease-free survival(DFS)were added.Statistical methods similar to those used in first part were used to assess the effect of PORT on OS and DFS and to validate and screen for beneficiary subgroups.Results:A total of 1857 cases were identified from the SEER database,of which 1005(54.1%)received POCRT,while 852(45.9%)received POCT.3 variables,primary site,number of positive lymph nodes(PLN)and surgical approach were imbalanced(all p<0.05).A total of 828 pairs and 1656 cases were balanced after PSM.Male,age ≥60 years,T3 stage and PLN≥5 were prognostic risk factors(all p<0.05).There was no significant correlation between PORT and OS or CSS(p=0.191,0.148).OS(48 vs 44 months,p=0.365)and CSS were not significantly different between the POCRT and POCT groups(57 vs 50 months,p=0.333).However,PORT improved survival in patients with PLN≥ 5(p=0.021,0.070).The survival benefit of PORT increased with increasing T stage.In Part Ⅱ,249 patients were included,of whom 179(71.9%)received POCT,while 70(28.1%)received POCRT.PORT was an independent prognostic factor associated with improved OS(HR 0.550,95%CI 0.352-0.860,p=0.009)and DFS(HR 0.613,95%CI 0.428-0.878,p=0.008).PORT provided significant OS and DFS benefits forⅢA-N2 patients(p=0.037,0.024).For lymph node status,PORT improved OS and DFS in patients with PLN≥3 and N2 PLN≥2(all p<0.05).PORT also has a positive impact on patients with T2 stage.Conclusions:For patients with ⅢA-N2 NSCLC and POCT,PORT significantly improved DFS while the positive effect on OS was applicable to specific subgroups.Patients with T2 and T3 stage were the beneficiary subgroups of PORT.PLN≥3 and N2 PLN≥2 were dominant subgroups.
Keywords/Search Tags:PORT, NSCLC, ⅢA-N2, Lymph nodes status, T stage
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