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Background Currently, there is no consensus on the role of postoperative adjuvant radiotherapy (PORT) for resected stage IIIA/N2 non‐small cell lung cancer (NSCLC). Our study sought to determine which patients may be able to benefit from PORT, based on a patient prognostic score. Methods A retrospective cohort study was conducted to identify patients diagnosed with IIIA/N2 NSCLC between 1988 and 2016 in the SEER database. Eligible patients were divided into the following two groups: PORT group and non‐PORT group. We classified patient prognostic scores as an ordinal factor and stratified patients based on prognostic scores. A Cox proportional hazards model with propensity score weighting was performed to evaluate cancer‐specific mortality (CSM) between the two groups. Results We identified 7060 eligible patients with IIIA/N2 NSCLC, 2833 (40.1%) in the PORT group and 4227 (59.9%) in the non‐PORT group. Overall, the 10‐year CSM rate in the weighted cohorts was 70.4% in the PORT group, 72.0% in the non‐PORT group, and patients who received PORT had a lower CSM rate (p = 0.001). Compared with the non‐PORT group, significant survival improvements in the PORT group were observed in patients with higher age, grade, T stage and lymph node ratio (LNR), and without chemotherapy. The improved survival of patients receiving PORT was significantly correlated with patient prognostic scores (p < 0.001). Conclusions In our population‐based study, the prognostic score was associated with the survival improvement offered by PORT in IIIA/N2 NSCLC, suggesting that prognostic scores and clinicopathological characteristics may be helpful in proper candidate selection for PORT.

BackgroundA giant thoracic neoplasm is extremely rare and poorly understood. Our systemic study introduced computed tomography angiography (CTA) with three‐dimensional (3D) reconstruction imaging and evaluated correlations between imaging, pathology, and surgical management.MethodsData from 45 patients undergoing surgery for giant thoracic neoplasm in our institution between May 2007 and November 2015 were collected. The clinical characteristics, imaging manifestations, preoperative biopsy, surgical management, postoperative pathology, and prognosis and their correlation were analyzed.ResultsThe clinical characteristics, imaging manifestations, and pathological types were complicated. Four patients underwent CTA with 3D reconstruction imaging and feeding vessels were found in three cases. Twenty‐four selected patients accepted preoperative biopsy, eight of which were inconsistent with postoperative pathology. Complete resection was performed in 39 cases, 20 of which underwent extended excision. The median survival duration of all patients was 58 months (range 3.0–118.0). The one, three, and five‐year survival rates were 86.0%, 64.4%, and 47.0%, respectively. Univariate analyses showed tumor size and resection status were prognostic factors for survival (P = 0.003 and P < 0.001, respectively).ConclusionsA giant thoracic neoplasm should preferably be treated in experienced centers for precise diagnosis and optimal therapy schemes with comprehensive consideration of clinical characters, imaging manifestations, pathology, surgical management, and prognosis. Innovative CTA with 3D reconstruction imaging together with preoperative biopsy are feasible and effective in therapeutic decision‐making and surgical planning. Complete surgical resection remains the mainstay of curative therapy for all resectable tumors.

BackgroundCurrently, the role of immunotherapy in neoadjuvant setting for patients with locally advanced esophageal squamous cell carcinoma (ESCC) is gradually attracting attention. Few studies compared the efficacy of neoadjuvant immunochemotherapy (NICT) and neoadjuvant chemoradiotherapy (NCRT). Our study aimed to compare treatment response and postoperative complications after NICT followed by surgery with that after conventional NCRT in patients with locally advanced ESCC.MethodsOf 468 patients with locally advanced ESCC, 154 received conventional NCRT, whereas 314 received NICT. Treatment response, postoperative complications and mortality between two groups were compared. Pathological response of primary tumor was evaluated using the Mandard tumor regression grade (TRG) scoring system. Pathological complete response (pCR) of metastatic lymph nodes (LNs) was defined as no viable tumor cell within all resected metastatic LNs. According to regression directionality, tumor regression pattern was summarized into four categories: type I, regression toward the lumen; type II, regression toward the invasive front; type III, concentric regression; and type IV, scattered regression. Inverse probability propensity score weighting was performed to minimize the influence of confounding factors.ResultsAfter adjusting for baseline characteristics, the R0 resection rates (90.9% vs. 89.0%, P=0.302) and pCR (ypT0N0) rates (29.8% vs. 34.0%, P=0.167) were comparable between two groups. Patients receiving NCRT showed lower TRG score (P&lt;0.001) and higher major pathological response (MPR) rate (64.7% vs. 53.6%, P=0.001) compared to those receiving NICT. However, NICT brought a higher pCR rate of metastatic LNs than conventional NCRT (53.9% vs. 37.1%, P&lt;0.001). The rates of type I/II/III/IV regression patterns were 44.6%, 6.8%, 11.4% and 37.1% in the NICT group, 16.9%, 8.2%, 18.3% and 56.6% in the NCRT group, indicating a significant difference (P&lt;0.001). Moreover, there were no significant differences in the incidence of total postoperative complications (35.8% vs. 39.9%, P=0.189) and 30-d mortality (0.0% vs. 1.1%, P=0.062).ConclusionFor patients with locally advanced ESCC, NICT showed a R0 resection rate and pCR (ypT0N0) rate comparable to conventional NCRT, without increased incidence of postoperative complications and mortality. Notablely, NICT followed by surgery might bring a promising treatment response of metastatic LNs.

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Background: Multiple clinical trials were conducted to evaluate the efficacy of neoadjuvant therapy in esophageal cancer but exhibited mixed results, indicating that the efficacy of neoadjuvant therapy remains controversial in the treatment of esophageal cancer. Our study was conducted to investigate the value of neoadjuvant therapy in patients with esophageal cancer with supraclavicular lymph node metastases.Methods: We retrospectively enrolled 231 patients who had resectable esophageal squamous cell carcinoma (ESCC) with supraclavicular lymph node metastases from June 2008 to November 2018. All patients were divided into three groups: the neoadjuvant therapy combined with surgery (Neo + S) group, the radical chemoradiotherapy (CRT) group, and the single radiotherapy (RT) group. Propensity score matching (PSM) was conducted to exclude the impact of potential interferences. Kaplan-Meier analysis, the log-rank test, and competitive risk model analysis were used to assess the efficacy of different therapeutic methods.Results: Patients in the Neo + S group had a better 3-year survival rate (72.0% vs. 35.8%; P=0.005), progression-free survival (PFS) (24 vs. 14 months; P<0.0001), and lower 3-year tumor-specific mortality risk (25.1% vs. 53.7%; P=0.005) than those in the CRT group. Furthermore, patients in the CRT group had a better 3-year survival (30.1% vs. 18.6%; P=0.012) and lower 3-year tumor-specific mortality risk (57.9% vs. 76.8%; P=0.011) than those in the RT group. Additionally, the supraclavicular lymph node metastasis rate was higher than the mediastinal lymph node metastasis rate in patients with upper esophageal cancer compared to middle and lower esophageal cancer Conclusions: Neoadjuvant chemotherapy combined with surgery showed better efficacy than radical CRT in patients who had resectable ESCC with supraclavicular lymph nodes metastasis. Supraclavicular lymph nodes are more likely to be regional lymph nodes for upper and middle esophageal cancer.

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