The impact of order with radiation therapy in stage IIIA pathologic N2 NSCLC patients: a population-based study

Abstract

Background: The aim of this study was to investigate the optimal order of radiation therapy in patients affected by stage IIIA pathologic N2 (IIIA/N2) non-small-cell lung cancer (NSCLC) and to identify its potential risk factors. Methods: 17,654 (8786 men and 8868 women) diagnosed with NSCLC stage IIIA-N2 from 2004 to 2015 patients were identified in the Surveillance, Epidemiology, and End Results (SEER) database. Among the relevant clinical parameters, we evaluated overall survival (OS), lung cancer-specific survival (LCSS) and other variables such as age, sex and tumor size in patients who were treated with different combinations of surgery and radiotherapy strategies. Results: We discovered that surgery benefit in younger IIIA/N2 NSCLC patients (age ≤ 75), and compared with surgery only, preoperative radiotherapy significantly improved the survival rate most (p < 0.001). When we performed the OS and LCSS analysis in the subgroup of patients' age > 75 years old, who underwent postoperative radiotherapy (PORT) had the highest survival rate (p < 0.001). Multivariate analyses showed that the following parameters had a negative impact on survival: female sex, older age, no chemotherapy, large tumor size, high tumor grade, no surgery or radiotherapy. Conclusions: In IIIA/N2 NSCLC patients, surgery, radiotherapy and chemotherapy were associated with improved OS and LCSS. Younger patients underwent surgical resection and chemotherapy, the main population we studied, benefited most from preoperative radiotherapy in all orders with radiation therapy (p < 0.001). In patients more than 75 years old, there was no clear benefit from only surgery, and PORT was recommended in case of having surgery.

Operative versus Nonoperative Treatment in Patients with Advanced Non-Small-Cell Lung Cancer: Recommended for Surgery

“…Primary treatment strategies might be changing as systemic therapies develop, but some researchers have suggested that positive responses to systemic therapy would make more NSCLC patients eligible for operative management [ 18 , 26 , 27 ]. According to the Robinson classification, specific cases of N2-patients had a higher possibility of survival as a part of multimodal therapy after an operative therapy [ 28 , 29 ].…”

The Clinical Characteristics and Treatments for Large Cell Carcinoma Patients Older than 65 Years Old: A Population-Based Study

“…A propensity score-matching analysis enrolled 3334 resected stage IIIA-N2 NSCLC patients and demonstrated that postoperative radiotherapy could only offer significantly overall survival benefits to <60 years old group (5-year OS, 35.4% for postoperative radiotherapy vs. 28.9% for no postoperative radiotherapy; p = 0.026), but not to 60–79 years old group ( p = 0.062) and >80 years old group ( p = 0.198) [ 30 ]. However, a retrospective study analyzed 17,654 stage IIIA N2 NSCLC patients and found that the surgery alone group did not have survival benefits compared to the no surgery group, and postoperative radiotherapy was recommended in patients >75 years old [ 31 ]. Another retrospective research based on 2515 stage IIIA N2 NSCLC patients showed that the survival benefits of delayed radiation after surgery was more significant in patients >60 years old (Logrank p = 0.002) compared to patients ≤60 years old (Logrank p = 0.871) [ 32 ].…”

Effect of preoperative radiotherapy on overall survival in N2 non-small-cell lung cancer: a propensity score-matched analysis of Surveillance, Epidemiology, and End Results database

“…However, the differences were statistically significant before and after PSM in the lung SCC subgroups ( P = 0.000 and P = 0.043, respectively). More encouragingly, some studies have shown that PrORT is an independent prognostic factor of OS in patients with stage IIIA-N2 NSCLC, and there is no obvious benefit in AC [ 19–21 ]. To some extent, this is consistent with our conclusions.…”