Male Patients with Resected IIIA-N2 Non-Small-Cell Lung Cancer may Benefit from Postoperative Radiotherapy: A Population-Based Survival Analysis

Kou, Peisi; Lin, Jiamao; Zhang, Yan; J, Yu

doi:10.2217/fon-2018-0326

Cited by 12 publications

(15 citation statements)

References 27 publications

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“…The prognostic value of tumor size and pT stage in pIIIA-N2 NSCLC has also been investigated in some studies 36-38; the results indicated that tumor size and pT stage might be prognostic indicators for survival. A few studies tried to assess the efficacy of PORT according to the pT stage or tumor size, but yielded conflicting results 12, 15, 16, 22. The present meta-analysis showed no significant differences in OS between the PORT and non-PORT groups for either patients with tumor >3.0 cm or pT2-3 tumor or those with tumor 3.0 cm or less or pT1 tumor.…”

Section: Discussioncontrasting

confidence: 57%

“…Finally, one RCT and 12 retrospective studies were included in the meta-analysis. Because two Surveillance, Epidemiology, and End Results (SEER)-based studies 16, 17 covered the same population of tumor size >3 cm, the one with fewer data 16 was excluded from the subgroup analysis of tumor size >3 cm, and the study by Wang et al 17 with more data was retained. The characteristics of the eligible studies are summarized in Table 1.…”

Section: Resultsmentioning

confidence: 99%

“…Therefore, a number of studies investigated the efficacy of PORT for pIIIA-N2 NSCLC according to the N2 metastasis status. Several retrospective studies 14, 18, 19, including two population-based studies 16,17, demonstrated the benefit of PORT in terms of improving OS for patients with multiple N2 metastases or multiple N2 station involvement, but not for patients with single N2 station involvement. However, the subgroup analysis of a recent randomized phase II study 20 revealed that postoperative chemotherapy (POCT) alone was favored compared with POCRT in patients with multiple N2 station involvement.…”

Section: Discussionmentioning

confidence: 99%

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The role of postoperative radiotherapy for completely resected pIIIA-N2 non-small cell lung cancer patients with different clinicopathological features: a systemic review and meta-analysis

Liu

Dang

et al. 2019

J. Cancer

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Background : The role of postoperative radiotherapy (PORT) in completely resected pathological stage IIIA-N2 (pIIIA-N2) non-small cell lung cancer (NSCLC) remains controversial. This meta-analysis aimed to assess the effect of PORT in patients with pIIIA-N2 NSCLC on the basis of clinicopathological features. Methods : The PubMed, PubMed Central (PMC), Embase, Web of Science, and Cochrane Library were searched for relevant studies. The main outcomes were overall survival (OS) and disease-free survival (DFS), which were compared using the hazard ratio (HR). Results : One randomized trial and 12 retrospective studies were eligible for the analysis. PORT significantly improved both OS [HR = 0.85; 95% confidence interval (CI): 0.79-0.92] and DFS (HR = 0.57; 95% CI: 0.38-0.85) compared with non-PORT treatment in patients with multiple N2 metastases or multiple N2 station involvement. No significant difference in either OS (HR = 1.03; 95% CI: 0.86-1.24) or DFS (HR = 1.08; 95% CI: 0.70-1.65) was found between PORT and non-PORT groups for patients with single N2 station involvement. No significant heterogeneity was observed. No significant differences in OS were observed between PORT and non-PORT groups for patients of different ages, sex, tumor sizes or pT stages, and histological types. Conclusions : The findings of this meta-analysis supported a role for PORT in patients with completely resected pIIIA-N2 NSCLC having multiple N2 metastases and favored withholding PORT to patients with single N2 station involvement. Further prospective randomized controlled trials are needed to confirm the findings.

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Section: Discussioncontrasting

confidence: 57%

Section: Resultsmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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The role of postoperative radiotherapy for completely resected pIIIA-N2 non-small cell lung cancer patients with different clinicopathological features: a systemic review and meta-analysis

Liu

Dang

et al. 2019

J. Cancer

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“…21 Several clinicopathological factors such as number of N2 status, smoking history, tumor size and sex have been reported to be associated with patient survival rates. [7][8][9][10][11][12] Therefore, the estimate of the benefit of PORT for pIIIA-N2 NSCLC should be individualized. The aim of this study was to assess the potential effect of PORT on histologically different subgroups of completely resected pIIIA-N2 NSCLC.…”

Section: Discussionmentioning

confidence: 99%

“…N2 status and other factors including smoking, large primary tumor and male sex played an important role in determining the efficiency of PORT. [7][8][9][10][11][12] In addition, histological subtypes of NSCLC may also contribute to the sensitivity to PORT. Lung adenocarcinoma (LADC) and squamous cell carcinoma (LSCC) are the most frequent subtypes of NSCLC, accounting for 50% and 30% of the cases, respectively.…”

Section: Introductionmentioning

confidence: 99%

Postoperative radiotherapy for patients with completely resected pathological stage IIIA-N2 non-small cell lung cancer: a preferential benefit for squamous cell carcinoma

Tian

Liu

et al. 2020

Radiology and Oncology

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BackgroundThe beneficial effect of postoperative radiotherapy (PORT) on completely resected pathological IIIA-N2 (pIIIA-N2) non-small cell lung cancer (NSCLC) has been a subject of interest with controversy. The aim of the study was to distinguish the clinical efficacy of PORT on lung adenocarcinoma (LADC) and lung squamous cell carcinoma (LSCC) among pIIIA-N2 NSCLC.Patients and methodsBetween October 2010 and September 2016, 288 consecutive patients with completely resected pIIIA-N2 NSCLC at Beijing Chest Hospital were retrospectively analyzed, which consisted of 194 cases of LADC and 85 cases of LSCC. There were 42 (21.6%) patients treated with PORT in LADC cases and 19 (22.3%) patients treated with PORT in LSCC cases. The 5-year overall survival (OS), loco-regional recurrence-free survival (LRFS), distant metastasis-free survival (DMFS) were calculated using the Kaplan-Meier method. The prognostic factors were determined using Cox’s regression model.ResultsAmong 194 cases of LADC, the 1-, 3-, and 5-year OS in the PORT group were 95.2%, 61.9% and 40.0%, respectively, while in the non-PORT group were 90.1%, 63.3% and 45.0% (p = 0.948). The use of postoperative chemotherapy (POCT) and smoking index ≥ 400 were both prognostic factors of 5-year rates of OS, LRFS and DMFS. On the other hand, among 85 cases of LSCC, the 1-, 3-, and 5-year OS in the PORT group were 94.7%, 63.2% and 63.2%, respectively, whereas in the non-PORT group were 86.4%, 48.5% and 37.1% (p = 0.026). In this group, only the use of PORT was a favorable prognostic factor for 5-year OS, LRFS and DMFS.ConclusionsDue to clinicopathological differences among completely resected pIIIA-N2 NSCLC, PORT may not be suitable to all patients. Our study distinguishes pIIIA-N2 LSCC from LADC by their positive responses to PORT.

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Prognostic factors for pN2 non-small cell lung cancer: a comprehensive evidence from 73 studies involving 23,772 patients*

Feng

Liang

et al. 2020

Oncology and Translational Medicine

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ObjectiveNon-small-cell lung cancer (NSCLC) is a common malignancy. pN2 NSCLC, with pathologically confirmed ipsilateral mediastinal/subcarinal nodes metastasis, has been known as a very heterogeneous subgroup in terms of its anatomical, biological and patient characteristics. Prognostic factors based on patient characteristics were not well determined yet in this subgroup, and there is currently no standard treatment recommendation for these heterogeneous pN2 subjects. Apparent disagreements and inconsistency exist in study reports concerning the prognostic significance of certain factors in pN2 NSCLC, especially regarding to the issue about whether skip N2 metastasis benefit from surgery.MethodsWe therefore performed this comprehensive summary of the published literatures to draw a more precise and less uncertain conclusion. After a comprehensive literature search, a total of 73 studies involving 23,773 subjects were included according to eligibility criteria.ResultsAs expected, most of the investigated factors, such as old age, male, advanced pathological T stage, advanced clinical N stage, multiple N2 stations, extended surgical resection (pneumonectomy), and incomplete resection, but not post-operation treatment (eg. chemotherapy and radiotherapy) were significantly associated with poor survival. However, skip N2 metastasis was favourable prognostic factors in operable pN2 NSCLC subjects. Other factors (histological type and primary tumour side) were neutral in terms of association with overall survival. We highlighted a number of important prognostic factors for pN2 NSCLC patients. Particularly, patients with skip N2 disease benefit from surgery.ConclusionOur findings could be used as reference information for decision-making in clinical practice and future study design.

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Male Patients with Resected IIIA-N2 Non-Small-Cell Lung Cancer may Benefit from Postoperative Radiotherapy: A Population-Based Survival Analysis

Abstract: PORT could improve OS and CSS in male patients with resected IIIA-N2 non-small-cell lung cancer.

Cited by 12 publications

References 27 publications

The role of postoperative radiotherapy for completely resected pIIIA-N2 non-small cell lung cancer patients with different clinicopathological features: a systemic review and meta-analysis

The role of postoperative radiotherapy for completely resected pIIIA-N2 non-small cell lung cancer patients with different clinicopathological features: a systemic review and meta-analysis

Postoperative radiotherapy for patients with completely resected pathological stage IIIA-N2 non-small cell lung cancer: a preferential benefit for squamous cell carcinoma

Prognostic factors for pN2 non-small cell lung cancer: a comprehensive evidence from 73 studies involving 23,772 patients*

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