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

Abstract

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.

Patient prognostic scores and association with survival improvement offered by postoperative radiotherapy for resected IIIA/N2 non‐small cell lung cancer: A population‐based study

“…Our findings suggested that among patients with lower prognostic scores, there was no statistical difference in cancer‐specific survival between the PORT group and the non‐RT group, whereas patients with higher prognostic scores treated with PORT demonstrated a significantly statistical difference in the survival, compared with those in whom PORT was not used. Therefore, taken together with previous findings, 15‐18 these results indicated that treatments for IIIA/N2 NSCLC should be individualized. Further studies on the basis of patient prognostic‐score to determine which patients with resected IIIA/N2 NSCLC may be able to benefit most from PORT are required.…”

“…Moreover, patients with stage IIIA/N2 NSCLC are a heterogeneous population with different clinicopathological characteristics. Some clinicopathological factors have been reported to be independent risk factors for patients with poor prognosis, such as age, sex, grade, T stage, chemotherapy and LNR 14–18 . Mao et al 32 analyzing data from 1809 patients, developed a nomogram to predict the survival of stage IIIA–N2 NSCLC after surgery, based on certain clinical factors, such as age, sex, grade, histology, positive lymph nodes and lymph nodes examined.…”

“…However, patients with stage IIIA/N2 NSCLC are a heterogeneous population with different clinicopathological characteristics. Some clinicopathological factors have been previously reported to be associated with significant variability of survival, such as age, sex, grade, T stage, chemotherapy and positive/resected lymph node ratio (LNR) 14–18 . This indicates that treatments for IIIA/N2 NSCLC should be individualized.…”

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

“… 6 In general, in patients with different clinicopathological features, only selected patients benefit from PORT. 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.…”

Prognosis of severe lymphopenia after postoperative radiotherapy in non-small cell lung cancer: Results of a long-term follow up study

“…The role of postoperative radiation (PORT) in resectable non-small cell lung cancer (NSCLC) remains controversial, particularly in stage III disease [1] , [2] . The ANITA trial that indicated that patients with pN2 disease could benefit from PORT but patients with pN1 disease did not [3] .…”