A Multicenter Retrospective Analysis of Survival Outcome Following Postoperative Chemoradiotherapy in Non–Small-Cell Lung Cancer Patients With N2 Nodal Disease

Zou, Bingwen; Xu, Yong; Li, Tao; Li, Wenhui; Tang, Bangxian; Zhou, Lin; Lu, Li; Liu, Yongmei; Zhu, Jiang; Huang, Meijuan; Wang, Jin; Ren, Li; Gong, Youlin; Che, Guowei; Liu, Lunxu; Hou, Mingxiao; Lü, You

doi:10.1016/j.ijrobp.2009.05.044

Cited by 57 publications

(57 citation statements)

References 26 publications

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“…Overall survival according to treatment pattern: S ϩ C ϩ R ϭ surgery followed by chemotherapy and radiotherapy; S ϩ Rϭ surgery followed by radiotherapy; S ϩ C ϭ surgery followed by chemotherapy; S ϭ surgery alone. lieved to be the mechanism for the longer OS duration in patients with pN2 disease [13,16]. Unlike most other studies, a significantly lower rate of distant metastasis with PORT was observed in our present study.…”

Section: Discussioncontrasting

confidence: 67%

Postoperative Radiotherapy for Resected Pathological Stage IIIA–N2 Non-Small Cell Lung Cancer: A Retrospective Study of 221 Cases from a Single Institution

Dai

Hui

et al. 2011

The Oncologist

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After completing this course, the reader will be able to:1. Describe the present clinical practice and controversies regarding the use of PORT in resected pIIIA-pN2 NSCLC.2. Evaluate the effect of PORT on overall survival and on tumor control in this subgroup of patients.This article is available for continuing medical education credit at CME.TheOncologist.com. CME CME ABSTRACTBackground. For patients with resected pathological stage IIIA-N2 non-small cell lung cancer (NSCLC), the role of postoperative radiotherapy (PORT) is not well defined. In this single-institutional study, we re-evaluated the effect of PORT on overall survival (OS) as well as tumor control in this subgroup of patients.

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Section: Discussioncontrasting

confidence: 67%

Postoperative Radiotherapy for Resected Pathological Stage IIIA–N2 Non-Small Cell Lung Cancer: A Retrospective Study of 221 Cases from a Single Institution

Dai

Hui

et al. 2011

The Oncologist

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“…Such technical factors likely substantially worsened the treatment mortality associated with PORT by simultaneously limiting the effectiveness of the therapy and increasing the likelihood of severe radiation pneumonitis 3 . The obsolete nature of the PORT meta-analysis data limits its applicability to modern practice, yet limited data have emerged to determine the potential role for PORT in the setting of involved N2 nodes 5,6,17–28 . Data justifying the use of PORT in addition to adjuvant chemotherapy are even more limited, with the largest study being the ANITA secondary analysis (224 pN2 patients, 118 received chemotherapy) 5 .…”

Section: Discussionmentioning

confidence: 99%

Postoperative Radiotherapy is Associated with Better Survival in Non–Small Cell Lung Cancer with Involved N2 Lymph Nodes: Results of an Analysis of the National Cancer Data Base

Mikell

Gillespie

Hall

et al. 2015

Journal of Thoracic Oncology

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Introduction Use of post-operative radiotherapy (PORT) in non-small cell lung cancer (NSCLC) remains controversial. Limited data indicate that PORT may benefit patients with involved N2 nodes. This study evaluates this hypothesis in a large retrospective cohort treated with chemotherapy and contemporary radiation techniques. Methods The National Cancer Data Base (NCDB) was queried for patients diagnosed 2004–2006 with resected NSCLC and pathologically involved N2 (pN2) nodes also treated with chemotherapy. Multivariable Cox proportional hazards model was used to assess factors associated with overall survival (OS). Inverse probability of treatment weighting (IPTW) using the propensity score was used to reduce selection bias. OS was compared between patients treated with vs. without PORT using the adjusted Kaplan-Meier estimator and weighted log-rank test based on IPTW. Results 2115 patients were eligible for analysis. 918 (43.4%) received PORT, 1197 (56.6%) did not. PORT was associated with better OS (median survival time (MST) 42 months with PORT vs. 38 months without, p=.048). This effect was significant in multivariable and IPTW Cox models (HR 0.87, 95% CI 0.78–0.98, p=.026, and HR 0.89, 95% CI 0.79–1.00, p=.046, respectively). No interaction was seen between the effects of PORT and number of involved lymph nodes (p=.615). Conclusions PORT was associated with better survival for patients with pN2 nodes also treated with chemotherapy. No interaction was seen between benefit of PORT and number of involved nodes. These findings reinforce the benefit of PORT for N2 disease in modern practice using the largest, most recent cohort of chemotherapy-treated pN2 patients to date.

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“…Previous studies have shown that young patients had a similar survival as older patients [8,13,15]. In contrast, some studies have reported that younger patients have better outcomes [5,16,17].…”

Section: Introductionmentioning

confidence: 99%

Advanced non-small cell lung cancer in patients aged 45 years or younger: outcomes and prognostic factors

et al. 2012

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BackgroundLung cancer in young patients (less or equal to 45 years) is uncommon and has clinical characteristics different from that in older patients. We investigated the outcomes and prognostic factors of young patients with advanced non-small cell lung cancer (NSCLC).MethodsFrom January 2000 to December 2009, we enrolled patients aged ≤45 years and diagnosed with stage IIIB or IV NSCLC. Their clinical data, including age, gender, performance status, histologic types, disease stages, laboratory data at diagnosis, treatment modalities, and survival were reviewed and analyzed. A Cox proportional hazard model was used to calculate the hazard ratio (HR) and its 95% confidence interval (CI).ResultsA total of 144 patients with advanced NSCLC were included. Female patients were more prevalent (n = 74, 51.4%). Adenocarcinoma was the most common histologic type (n = 119, 82.6%) in both genders (male, n = 54, 77.1%; female, n = 65, 87.8%). Epidermal growth factor receptor (EGFR) sequences were determined using tumor specimens from 58 patients, and 29 showed an EGFR mutation. No significant difference in median survival was found between patient groups with and without the EGFR mutation (798 vs. 708 days, p = 0.65). In multivariate analysis, male gender (HR, 1.70; 95% CI: 1.08-2.68), body mass index (BMI) less than 25 kg/m2 (HR, 2.72; 95% CI: 1.39-5.30), stage IV disease (HR, 2.62; 95% CI: 1.50-4.57), and anemia (HR, 2.08; 95% CI: 1.15-3.77) were associated with a short survival time.ConclusionsLow BMI, stage IV disease, anemia at diagnosis, and male gender were the negative prognostic factors for young patients with advanced NSCLC.

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A Multicenter Retrospective Analysis of Survival Outcome Following Postoperative Chemoradiotherapy in Non–Small-Cell Lung Cancer Patients With N2 Nodal Disease

Cited by 57 publications

References 26 publications

Postoperative Radiotherapy for Resected Pathological Stage IIIA–N2 Non-Small Cell Lung Cancer: A Retrospective Study of 221 Cases from a Single Institution

Postoperative Radiotherapy for Resected Pathological Stage IIIA–N2 Non-Small Cell Lung Cancer: A Retrospective Study of 221 Cases from a Single Institution

Postoperative Radiotherapy is Associated with Better Survival in Non–Small Cell Lung Cancer with Involved N2 Lymph Nodes: Results of an Analysis of the National Cancer Data Base

Advanced non-small cell lung cancer in patients aged 45 years or younger: outcomes and prognostic factors

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