Role of Postoperative Radiotherapy After Curative Resection and Adjuvant Chemotherapy for Patients With Pathological Stage N2 Non–Small-Cell Lung Cancer: A Propensity Score Matching Analysis

Kim, Byoung Hyuck; Kim, Hak Jae; Wu, Hong‐Gyun; Kang, Chang Hyun; Kim, Young Tae; Lee, Se‐Hoon; Kim, Dong-Wan

doi:10.1016/j.cllc.2014.05.005

Cited by 28 publications

(40 citation statements)

References 28 publications

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“…Patients with N1 or N0 disease who received adjuvant radiotherapy experienced decreased survival [26]. Similarly, single-institution studies by Kim and colleagues [27] of 219 patients and Matsuguma and colleagues [28] of 112 patients with N2 NSCLC found no differences in overall survival imparted by postoperative radiation therapy.…”

Section: Commentmentioning

confidence: 96%

Adding Radiotherapy to Adjuvant Chemotherapy Does Not Improve Survival of Patients With N2 Lung Cancer

Drake

Portnoy

Tauer

et al. 2018

The Annals of Thoracic Surgery

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Section: Commentmentioning

confidence: 96%

Adding Radiotherapy to Adjuvant Chemotherapy Does Not Improve Survival of Patients With N2 Lung Cancer

Drake

Portnoy

Tauer

et al. 2018

The Annals of Thoracic Surgery

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“…Our initial database search identified 763 potential full-text trials. Of these, 675 articles were excluded because they did not meet the inclusion criteria, and six were judged to be eligible for inclusion 13 , 14 , 25 – 28 ( Figure 1 ). The research in the included studies was performed by Robinson et al 13 in the US, Shen et al 14 in the People’s Republic of China, Kim et al 25 in Korea, Zou et al 28 in the People’s Republic of China, Perry et al 26 in France, and Douillard et al 27 in the US.…”

Section: Resultsmentioning

confidence: 99%

“…A total of six studies, including two RCTs 14 , 26 and four retrospective studies, 13 , 25 , 27 , 28 were enrolled in this meta-analysis for a total of 5,172 cases of N2 NSCLC. This cohort included 2,125 cases of postoperative chemoradiotherapy (POCRT) and 3,047 cases of POCT.…”

Section: Resultsmentioning

confidence: 99%

Adjuvant chemotherapy plus radiotherapy is superior to chemotherapy following surgical treatment of stage IIIA N2 non-small-cell lung cancer

Tao

Chen

et al. 2016

OTT

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The use of additional radiotherapy for resected stage IIIA N2 non-small-cell lung cancer in the setting of standard adjuvant chemotherapy remains controversial. A comprehensive search (last search updated in March 2015) for relevant studies comparing patients with stage IIIA N2 non-small-cell lung cancer undergoing resection after treatment with adjuvant postoperative chemotherapy alone or adjuvant postoperative chemoradiotherapy (POCRT) was conducted. Hazard ratios (HRs) were extracted from these studies to give pooled estimates of the effects of POCRT on overall survival (OS) and disease-free survival (DFS). Six studies were included. The meta-analysis demonstrated that POCRT had a greater OS benefit than postoperative chemotherapy (HR =0.87, 95% confidence interval [CI]: 0.79–0.96, P=0.006). Unfortunately, there was no significant difference in DFS between the two groups: the combined HR for DFS was 0.91 (95% CI: 0.57–1.46, P=0.706). In a subgroup analysis of two randomized controlled trials (n=172 patients), adding radiation was of no benefit to either OS (HR =0.72, 95% CI: 0.49–1.06, P=0.094) or DFS (HR =1.45, 95% CI: 1.00–2.09, P=0.047). In summary, compared with postoperative chemotherapy, POCRT was beneficial to OS but not DFS in patients with stage IIIA N2 non-small-cell lung cancer.

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“…2b, e). pN1N2b patients who received no adjuvant therapy (5 cases), adjuvant chemotherapy alone (17) or chemoradiotherapy (6) exhibited significantly different five-year OS (0.0%, 0.0%, and 33.3%, respectively, P < 0.0001) and DFS (0.0%, 0.0%, and 16.7%, respectively, P < 0.0001) ( Fig. 2c, f).…”

Section: Survival Comparisonmentioning

confidence: 99%

“…Although the role of postoperative treatments, including postoperative radiation therapy (PORT), was demonstrated in our previous study 14 and those of others, [15][16][17] not all patients benefit from PORT. [18][19][20] Improvement in the survival of pIIIa-N2 patients who underwent PORT has been very limited.…”

Section: Introductionmentioning

confidence: 95%

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

et al. 2015

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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.

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Role of Postoperative Radiotherapy After Curative Resection and Adjuvant Chemotherapy for Patients With Pathological Stage N2 Non–Small-Cell Lung Cancer: A Propensity Score Matching Analysis

Cited by 28 publications

References 28 publications

Adding Radiotherapy to Adjuvant Chemotherapy Does Not Improve Survival of Patients With N2 Lung Cancer

Adding Radiotherapy to Adjuvant Chemotherapy Does Not Improve Survival of Patients With N2 Lung Cancer

Adjuvant chemotherapy plus radiotherapy is superior to chemotherapy following surgical treatment of stage IIIA N2 non-small-cell lung cancer

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

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