Reappraisal of the role of postoperative radiation therapy in patients with pIIIa‐N2 non‐small cell lung cancer: A propensity score matching analysis

Abstract

BackgroundReappraisal of the role of postoperative radiotherapy in pN2 non-small cell lung cancer (NSCLC) patients according to N1 lymph node involvement.MethodsA total of 218 pIIIa-N2 NSCLC patients who underwent complete surgical resection with systematic nodal dissections were enrolled. Propensity scores were used for matching N1 involvement. Overall survival (OS) and disease-free survival (DFS) were analyzed retrospectively.ResultsAfter matching, pN2b patients without N1 involvement (pN0N2b) exhibited better prognoses than those with N1 involvement (pN1N2b) (5-year OS: 37.5% vs. 7.1%, P = 0.008; 5-year DFS: 31.8% vs. 4.6%, P = 0.004). Similar results were not detected in pN2a disease (5-year OS: 37.8% vs. 31.0%, P = 0.517; 5-year DFS: 27.1% vs. 20.2%, P = 0.788). The five-year OS of patients who received no adjuvant therapy (22 pN2a cases, 7 pN0N2b, 5 pN1N2b), adjuvant chemotherapy alone (74 pN2a cases, 11 pN0N2b, 17 pN1N2b) or chemoradiotherapy (25 pN2a cases, 7 pN0N2b, 6 pN1N2b) were compared (pN2a: 31.3%, 37.0%, and 32.0%, P = 0.808; pN0N2b: 0.0%, 18.2%, and 71.4%, P = 0.108; pN1N2b: 0.0%, 0.0%, and 33.3%, P < 0.0001). The five-year DFS was also analyzed (pN2a: 31.6%, 24.0%, and 18.3%, P = 0.410; pN0N2b: 0.0%, 11.1%, and 57.1%, P = 0.192; pN1N2b: 0.0%, 0.0%, and 16.7%, P < 0.0001). Multivariate analysis revealed that the novel classification based on N1 involvement and pN2a/pN2b staging was an independent prognostic factor of OS and DFS.ConclusionN1 involvement significantly impacted the prognosis of pN2b NSCLC patients. The benefit of adjuvant therapy in pN2a and pN0N2b patients requires confirmation by further study.

Mediastinal radiotherapy after adjuvant chemotherapy for resected non–small cell lung cancer with N2 lymphadenopathy: A novel meta-analysis

“…Sixteen studies met the inclusion criteria but 6 were excluded because reported data did not allow extraction of comparison survival outcomes for the groups of interest 21 , 22 , 23 , 24 , 25 , 26 ( Figure 1 ). The 10 remaining studies 27 , 28 , 29 , 30 , 31 , 32 , 33 , 34 , 35 , 36 included 3 prospective studies, including 2 randomized controlled trials addressing the specific question of this meta-analysis, 4 retrospective studies, and 3 national database analyses, giving a pooled dataset of 18,077 patients (5453 [30.2%] receiving PORT and 12,624 [69.8%] without). Characteristics of included studies are shown in Table 1 , with resection type, chemotherapy regimens, and radiotherapy details summarized in Table 2 .…”

“…Five studies provided Kaplan–Meier estimates of DFS comparing PORT with no PORT. 27 , 31 , 33 , 35 , 36 Median DFS ranged from 16.8 to 25.5 months in the no-PORT groups and 25.8 to 33.7 months in the PORT groups. PORT significantly improved DFS at 1 year (n = 676; HR, 0.733; 95% CI, 0.414-1.052, P < .0001), 3 years (n = 676; HR, 0.732; 95% CI, 0.566-0.898; P < .0001) and 5 years (n = 639; HR, 0.735; 95% CI, 0.589-0.880; P < .0001).…”

“…Sixteen studies met the inclusion criteria but 6 were excluded because reported data did not allow extraction of comparison survival outcomes for the groups of interest [21][22][23][24][25][26] (Figure 1). The 10 remaining studies [27][28][29][30][31][32][33][34][35][36] 2.…”

“…Disease-free survival. Five studies provided Kaplan-Meier estimates of DFS comparing PORT with no PORT 27,31,33,35,36. Median DFS ranged from 16.8 to 25.5 months in the no-PORT groups and 25.8 to 33.7 months in the PORT groups.…”

Causation between Pathway Completion and Reduced Hospital Stay in Patients with Lung Cancer: a Retrospective Cohort Study Using Propensity Score Matching

“…A number of studies have applied PSM methods to divide patients into targeting groups and control groups, similar to randomized clinical trials. For example, a family history of lung cancer [2], postoperative radiotherapy [3], the use of betablockers [4], preoperative radiotherapy [5], intermittent chest tube clamping [6], systematic lymph node dissection and lobe-specific lymph node dissection [7], as well as other variables [8][9][10][11][12], have been used to divide patients into the two groups. Most cancer studies estimate survival curves as related to the N-years survival rate as their main outcome.…”