The Value of Radiotherapy in Patients With Resectable Stage IIIA Non–Small-Cell Lung Cancer in the Era of Individualized Treatment: A Population-Based Analysis

Liu, Bohao; Wang, Zhiyu; Zhao, Heng; Gao, Shan; Wang, Hongyi; Zhang, Yanpeng; Fan, Kun; Tao, Runyi; Li, Yixing; Feng, Jinteng; Sun, Yuchen; Zhang, Jia; Zhang, Guangjian

doi:10.1016/j.cllc.2022.09.011

Cited by 5 publications

(2 citation statements)

References 45 publications

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“…Shinde et al concluded that there was no benefit observed for adjuvant CT or RT in the entire cohort which include patients with non-metastatic, cN2 (IIIA or IIIB) NSCLC diagnosed from 2004 to 2015 17 . However, Liu et al reported that patients can benefit from adjuvant RT if they have more than 5 positive RLNs, larger tumors (≥3cm), and older age (≥65 years old) 20 . In our research, whether in the whole cohort or in patients with RLNs removed, less patients chose RT than did not and the proportion of RT applied was keeping reducing with the number of RLNs removed increasing.…”

Section: Discussionmentioning

confidence: 99%

The Valuable Prognostic Impact of Regional Lymph Node Removed on Outcomes for IIIA N0 NSCLC Patients

Wang¹,

Liu²,

Zhou³

et al. 2023

J. Cancer

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Background: Regional lymph nodes (RLNs) removed combined with surgery is a standard option for patients at stage I to IIIA NSCLC. The objective of the study is to clarify the effect of removing different number of RLNs on survival outcomes for patients at stage IIIA N0 NSCLC. Methods: Patients at stage IIIA N0 NSCLC from 2004 to 2015 were identified from Surveillance, Epidemiology, and End Results (SEER) database. Prior propensity score method (PSM), survival time was compared among different number (0, 1-3 and ≥4) of RLNs removed groups. After PSM, lung cancer-specific survival (LCSS) and overall survival (OS) were compared. Kaplan-Meier analysis and Cox regression analyses were used to clarify the impact of the factors on the prognosis with hazard ratio (HR) and 95% confidence interval (CI). Results: A total of 11,583 patients at stage IIIA N0 NSCLC were included. Prior PSM, survival indicators including 1-year mortality rate, 5-year mortality rate, median survival time (MDST) and mean survival time (MST) from good to bad were all: ≥4, 1-3 and none RLNs removed group. After PSM, Kaplan-Meier survival analyses and univariate Cox regression analyses on OS and LCSS revealed a statistically significance on survival curve ( P <0.001) between each two of the three groups (none, 1-3 and ≥4 RLNs removed group). Multivariable Cox regression analyses on OS and LCSS showed an independent association of RLNs removed with higher OS (HR, 0.275; 95% CI, 0.259-0.291; P <0.001) and LCSS (HR, 0.239; 95% CI, 0.224-0.256; P <0.001) compared with none RLN removed and no statistical difference with OS (HR, 1.118; 95% CI, 0.983-1.271; P =0.088) and LCSS (HR, 1.107; 95% CI, 0.954-1.284; P =0.179) between 1-3 RLNs removed and ≥4 RLNs removed. Conclusions: Removing RLNs was beneficial to survival outcomes of patients at stage IIIA N0 NSCLC. Compared with 1-3 RLNs removed, ≥4 RLNs removed could bring a better survival time but not an independent prognostic factor ( P >0.05).

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Section: Discussionmentioning

confidence: 99%

The Valuable Prognostic Impact of Regional Lymph Node Removed on Outcomes for IIIA N0 NSCLC Patients

Wang¹,

Liu²,

Zhou³

et al. 2023

J. Cancer

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“…They found that selected patients who received PORT had a signi cantly improved OS. They recommended that pN2 NSCLC patients who were elderly (> 65 years), had visceral pleural invasion, larger tumour size (> 3 cm), or > 5 mediastinal lymph nodes should receive PORT after complete surgical resection [24]. Fan et al analysed the impact of LNR on OS in patients with pN2 NSCLC who were administered PORT with complete resection using the National Cancer Database.…”

Section: Discussionmentioning

confidence: 99%

A novel nomogram to identify the III-N2 non-small cell lung cancer patients who may benefit from adjuvant radiotherapy

Deng

et al. 2023

Preprint

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Purpose We aimed to develop a novel risk stratification system based on a prognostic nomogram to identify patients with pIII-N2 non-small cell lung cancer (NSCLC) who may benefit from postoperative radiotherapy (PORT) after complete resection. Methods We retrospectively enrolled 3,520 eligible NSCLC patients with pIII-N2 stage disease from the Surveillance, Epidemiology, and End Results database. Stabilized inverse probability of treatment weighting (sIPTW) was used to equilibrate the characteristic baseline to reduce bias. We established a risk stratification tool using a nomogram that incorporated independent factors identified using least absolute shrinkage and selection operator (LASSO) Cox regression. Kaplan–Meier and subgroup survival analyses were conducted to estimate the benefit of PORT in every risk stratification. Results Kaplan–Meier survival analysis observed that high-risk patients owned a significant improvement in overall survival (OS) after PORT (p = 0.002), while those in low- or intermediate-risk cohorts did not show such improvement. Subgroup survival analysis suggested that patients with a high lymph node ratio ≥ 0.56 (hazard ratio [HR] = 0.803; 95% confidence interval [CI]:0.661–0.975, p = 0.027), without postoperative chemotherapy (HR = 0.782; 95% CI: 0.619–0.989; p = 0.040), and those in the high-risk group (HR = 0.577; 95% CI: 0.410–0.812; p = 0.001) achieved a significant OS advantage from PORT. Conclusion This novel risk stratification system based on nomogram provides a preliminary identification of potential pIII-N2 NSCLC patients who are more likely to benefit from PORT.

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A review on non-small cell lung cancer

Verma,

Pandey,

Khare

et al. 2024

Vacunas

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The Value of Radiotherapy in Patients With Resectable Stage IIIA Non–Small-Cell Lung Cancer in the Era of Individualized Treatment: A Population-Based Analysis

Cited by 5 publications

References 45 publications

The Valuable Prognostic Impact of Regional Lymph Node Removed on Outcomes for IIIA N0 NSCLC Patients

The Valuable Prognostic Impact of Regional Lymph Node Removed on Outcomes for IIIA N0 NSCLC Patients

A novel nomogram to identify the III-N2 non-small cell lung cancer patients who may benefit from adjuvant radiotherapy

A review on non-small cell lung cancer

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