Propensity score-matching analysis of postoperative radiotherapy for stage IIIA-N2 non-small cell lung cancer using the Surveillance, Epidemiology, and End Results database

Abstract

BackgroundTo investigate the effects of postoperative radiotherapy (PORT) on the survival of patients with resected stage IIIA-N2 non-small cell lung cancer (NSCLC).MethodsA total of 3,334 patients with resected stage IIIA-N2 NSCLC in 2004 to 2013 were identified in the Surveillance, Epidemiology, and End Results database and stratified according to use of PORT. Propensity score-matching (PSM) methods were used to balance the baseline characteristics of patients who did (n = 744) or did not (n = 744) undergo PORT. Overall survival (OS) and lung cancer-specific survival (LCSS) were compared between these two patient groups.ResultsAfter PSM, PORT increased OS (hazard ratio, 0.793; p = 0.001) and LCSS (hazard ratio, 0.837; p = 0.022) compared with no PORT. The OS benefit for PORT was mainly seen in patients aged <60 years (5-year OS, 35.4% versus 28.9% for PORT versus no PORT, respectively; p = 0.026) and in those who underwent lobectomy (5-year OS, 43.5% versus 34.5% for PORT versus no PORT, respectively; p = 0.001). The LCSS benefit for PORT was significant in patients undergoing lobectomy (5-year LCSS, 48.3% versus 42.3% for PORT versus no PORT, respectively; p = 0.036).ConclusionsThe survival benefits of PORT were primarily observed in patients with resected stage IIIA-N2 NSCLC who were <60 years of age or had undergone lobectomy.

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 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.…”

Survival Patterns for Patients with Resected N2 Non–Small Cell Lung Cancer and Postoperative Radiotherapy: A Prognostic Scoring Model and Heat Map Approach

“…Also, the SEER database contains no information about chemoradiotherapy, metastatic LN stations, and some other factors that can influence the results from PORT. 13,14…”

Micropapillary pattern of pathologic IIIA-N2 lung adenocarcinoma is a prognostic factor after adjuvant chemoradiotherapy.

“…The results of the study found that pN 2 patients treated with postoperative chemotherapy combined with sequential PORT could obtain a longer median survival time (47.4 months Vs. 23.8 months) and a higher 5-year survival rate (47.4% Vs. 34.0%) than postoperative chemotherapy alone. After this, many large retrospective studies based on the SEER database or NCDB database showed that PORT could greatly reduce the risk of death in patients with IIIA N 2 resectable NSCLC [7,16]. A small sample prospective randomized controlled study published in 2014 compared the effect of postoperative adjuvant chemoradiotherapy (POCRT) and postoperative adjuvant chemotherapy (POCT) in patients with pIIIA N 2 [17].…”