| Objective:To analyze the influence factors of survival of the whole, surgical and non-surgical groups, and study the differences of survival between surgical and non-surgical groups of stage Ⅲa. To compare the survival of postoperative chemotherapy, postoperative radiotherapy, postoperative chemoradiotherapy and surgery alone groups of each stage of Ⅲa. To determine the effectiveness of concurrent chemoradiotherapy as compared to sequential chemoradiotherapy with regard to objective response rate (ORR), overall survival (OS) and progression free survival (PFS), and the effectiveness of surgery by comparing surgical and non-surgical patients after concurrent chemoradiotherapy. Meanwhile, to analyze the side effects of chemotherapy.Methods:Between March2002and October2012,310cases that have completed followed-up data with stage Ⅲa/Ⅲb of NSCLC were received in the Peking Union Medical College Hospital. One hundred and eighty-nine patients received surgery once confirmed. Eighty patients received postoperative chemotherapy, thirty-five patients received postoperative radiotherapy, fifty-six patients received postoperative chemoradiotherapy and eighteen patients received surgery alone. One hundred and twenty-one patients did not receive surgery when confirmed. Sixty-six patients received concurrent chemoradiotherapy and fifty-five patients received sequential chemoradiotherapy. Objective response rate was evaluated by RECIST criteria, and side effects were evaluated by WHO criteria. Analyzed the differences of objective response rate (ORR) and side effects by Chi-Square test. Kaplan-Meier survival method was used to calculate the overall survival (OS) and progression-free survival (PFS), and to proceed univariate analysis of survival. COX regression analysis was used to conduct multivariate analysis of survival. A p-value less than0.05were evaluated as statistically significant.Results:The median OS and PFS of the whole group were31.6and12.7months. And the1-year,3-year and5-year survival rates of the whole group were85.0%,46.0%and31.1%. Univariate analysis indicated that TNM stage, pathologic type and surgery were significant influence factors of OS of the whole group (P<0.05), and family history of tumor, TNM stage and surgery were significant influence factors of PFS (P<0.05), and that pathologic type and postoperative chemotherapy were significant influence factors of OS of the surgical group (P<0.05), and family history of tumor and maximum diameter of tumor were significant influence factors of PFS (P<0.05). Also it indicated that sex and therapy (concurrent or sequential chemoradiotherapy) were significant influence factors of OS of the non-surgical group, and therapy and diagnosed date (before or after January1,2010) were significant influence factors of PFS (P<0.05). Multivariate analysis indicated that surgery and chemotherapy had significant influences on OS of the whole group (P<0.05), and family history of tumor and surgery had significant influences on PFS (P<0.05), and that postoperative chemotherapy had a significant influence on OS of the surgical group (P<0.001), and family history of tumor had a significant influence on PFS (P<0.05). Also it indicated that sex and therapy had significant influences on OS of non-surgical group, and therapy had a significant influence on PFS (P<0.05). The median OS of postoperative chemotherapy, postoperative radiotherapy, postoperative chemoradiotherapy and surgery alone groups of stage T1-3N2M0which belongs to stage Ⅲa were58.4,19.8,44.0and27.0months. And the median PFS of them were 15.8,5.9,23.8,8.6months respectively. Compared with postoperative radiotherapy and surgery alone groups, the OS of postoperative chemotherapy and postoperative chemoradiotherapy groups showed significant differences (P<0.05). Comparing the PFS of postoperative chemoradiotherapy with postoperative chemotherapy and postoperative radiotherapy groups, there were significant differences (P<0.05). There were no significant differences among each group of T4N0/T3-4N1M0stage in surgical group. For non-surgical group’s concurrent and sequential groups, the ORR were45.5%and16.4%, the median OS were33.4and19.7months, and the median PFS were12.7and9.8months. The two groups had significant differences in the three aspects (P<0.05). The median OS of the surgical patients after concurrent chemoradiotherapy exceeded the longest follow-up period33.5months, and their median PFS was18.8months. The median OS and PFS of non-surgical patients were33.4and11.5months.Comparing the two groups, the OS and PFS had no significant differences (P>0.05). The median OS of surgical and non-surgical groups of stage Ⅲa were38.9and21.8months. The difference between them was significant (P<0.05). The analysis of side effects of chemotherapy showed that the incidence of myelosuppression of postoperative chemoradiotherapy had a significant increase compared with postoperative chemotherapy (P<0.05).Conclusions:For locally advanced NSCLC, surgery has significant influences on OS and PFS. The family history of tumor influences PFS significantly. For surgical patients, postoperative chemotherapy has a significant influence on OS and family history of tumor influences PFS significantly. For non-surgical patients, therapy has a significant influence on OS and PFS, and sex influences OS significantly. Surgery can prolong survival time of stage Ⅲa. For stage T1-3N2M0, postoperative chemotherapy can increase OS and PFS, and postoperative radiotherapy can prolong PFS. Compared with sequential chemoradiotherapy, concurrent chemoradiotherapy can significantly increase the ORR, OS and PFS. Postoperative chemoradiotherapy will significantly increase the incidence of myelosuppression compared with postoperative chemotherapy. |
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