| Objective: To compare the outcome of surgery and radiotherapy for clinical stage IIIA-N2 non-small-cell lung cancer(NSCLC) and analyze the prognostic factors.Methods and Materials: From January 2010 to December 2011, 177(144 male patients and 33 female patients) patients with clinical stage IIIA-N2 NSCLC at the Fourth Hospital of Hebei Medical University were collected. 64 patients received surgery(S group) and 113 patients received radiotherapy(R group). The median age was 64 years old. The median follow-up duration was 20 months(range, 0.5-57.5). Overall survival rates(OS), local control rates(LC), free from distant metastasis survival rates(FDM) and disease-free survival rates(DFS) were calculated using the Kaplan-Meier method. Univariate and multivariate analysis was done respectively by Log-rank test and Cox proportional hazard model, P<0.05 was defined as significant difference in statistics.Results: 1 The overall 1-, 2- and 3-year OS of entire cohort were 70.4%, 38.9% and 26.1%, respectively. The overall 1-, 2- and 3-year LC of entire cohort were 73.6%, 54.6% and 47.8%, respectively. The overall 1-, 2- and 3-year FDM of entire cohort were 66.3%, 48.1% and 40.2%, respectively. The overall 1-, 2- and 3-year DFS of entire cohort were 49.4%, 27.7% and 20.5%, respectively. Multivariate analysis showed that the independent variables of the entire patients included gender, ECOG performance status, adjuvant chemotherapy. 2 The median survival time, the 1-, 2-, 3-year OS was 21 months, 70.2%, 38.3, 30.1% and 19 months, 70.5%, 39.3%, 23.8% in the S and R groups, respectively(P=0.411). Likewise, the 1-, 2- and 3-year LC(P=0.840), FDM(P=0.622), DFS(P=0.913) in the two groups were not significantly different. 3 Prognostic factors in S group: The univariate analysis showed that the following factors were associated with the longer OS: good ECOG performance status, treatment regimen, adjuvant chemotherapy, adjuvant radiotherapy(P<0.05). And the following factors were significantly associated with the longer LC: the number of positive N2 no more than three, single N2 station, adjuvant radiotherapy(P<0.05). Multivariate analysis revealed that ECOG performance status and adjuvant radiotherapy were the independent factors for predicting the OS, the number of positive N2 and adjuvant radiotherapy were the independent factors for predicting the LC. 4 Prognostic factors in R group: ①Univariate analysis of OS: The 1-, 2- and 3-year OS in the male and female patients were 68.8%, 34.4%, 20.1% and 78.9%, 63.2%, 41.4%,respectively(P=0.033). The 1-, 2- and 3-year OS in the patients with good ECOG performance status and poor ECOG performance status were 83.3%, 83.3%, 66.7% and 25.0%, 25.0%, 0%, respectively(P=0.024). The 1-, 2- and 3-year OS in the adjuvant chemotherapy group and not adjuvant chemotherapy group were 76.1%, 46.3%, 29.3% and 62.2%, 28.9%, 15.6%,respectively(P=0.036). The 1-, 2- and 3-year OS in the patients with response to treatment of CR+PR were 68.8%, 34.4%, 20.1% and with response to treatment of SD+PD were 50.0%, 14.3%, 0%(P=0.004). ②Univariate analysis of LC: The 1-, 2- and 3-year LC in the patients with T1+2 and T3 were 85.8%, 67.7%, 55.9% and 65.4%, 38.4%, 38.4%, respectively(P=0.025). The 1-, 2- and 3-year LC in the patients with GTV<120cm3and GTV≥120cm 3 were 84.5%, 70.8%, 57.8% and 68.2%, 37.9%, 37.9%, respectively(P=0.027). The 1-, 2- and 3-year LC in the adjuvant chemotherapy group and not adjuvant chemotherapy group were 80.8%, 63.1%, 58.2% and 69.8%, 39.7%, 29.4%,respectively(P=0.017)。The 1-, 2- and 3-year LC in the patients with response to treatment of CR+PR were 75.7%, 59.3%, 52.0% and with response to treatment of SD+PD were 84.4%, 12.1%, 12.1%(P=0.040). ③ Multivariate analysis revealed that gender, ECOG performance status, adjuvant chemotherapy and response to treatment were the independent factors for predicting the OS; and GTV size, adjuvant chemotherapy and response to treatment were the independent factors for predicting the LC. 5 The patterns of failure: There were 21 cases(32.8%) with locoregional failure, 23 cases(35.9%) with distant metastasis, 1 cases(1.6%) with locoregional failure and distant metastasis at the same time in S group. There were 36 cases(31.9%) with locoregional failure, 47 cases(41.6%) with distant metastasis, 5 cases(4.4%) with locoregional failure and distant metastasis at the same time in R group. 6 There were 13.3%(15/113) patients with grade≥2 acute radiation-related pneumonitis after radiotherapy; there were 5.3%(6/113) patients with grade≥2 acute radiation esophagitis; there were 17.7%(20/113) patients with grade≥2 hematologic toxicity.Conclusions: 1 Surgery or radiotherapy for clinical Stage IIIA-N2 NSCLC results in similar outcomes in terms of overall survival rates, local control rates, distant metastasis-free survival rates and disease-free survival rates. 2 Female patients, good ECOG performance status and adjuvant chemotherapy, are favourable prognostic factors for overall survival rates of the entire patients. 3 Postoperative adjuvant radiotherapy can improve the overall survival rates and local control rates of stage IIIA-N2 NSCLC. 4 The number of positive N2 was independent prognostic factors for locoregional recurrence, and positive N2 no more than three confers higher local control rates in patients with surgery. 5 Unoperated patients who adjuvant chemotherapy and with response to treatment of CR+PR have better overall survival rates and local control rates. 6 GTV was the independent factors for predicting the local control rates, smaller GTV is a favourable prognostic factor for local control rate in patients with radiotherapy. |
PDF Full Text Request