The online version of this article (https://doi.org/10.1186/s13014-017-0946-1) contains supplementary material, which is available to authorized users.
Postoperative radiation (PORT) is an option for non-small cell lung cancer (NSCLC) patients with resectable stage IIIA pathological N2 status (pN2). For patients with PORT, this study aims to investigate the impact of the exact number of positive lymph nodes (LNs) on overall survival (OS) and lung cancer-specific survival (LCSS).
Within the Surveillance, Epidemiology, and End Results database, we identified 3373 patients with stage IIIA pathological N2 status (pN2) NSCLC who underwent a lobectomy or pneumonectomy from 2004 to 2013. OS and LCSS were compared among patients coded as receiving PORT or observation. The proportional hazards model was applied for investigation.
OS and LCSS favored PORT for patients with stage IIIA (pN2) NSCLC. Multivariable analyses showed that PORT and the exact number of positive LNs (n ≤ 3) were independently associated with better OS and LCSS. Both better OS and LCSS emerged for positive LNs (n > 3) after the use of PORT in survival analyses, whereas the benefits of OS and LCSS were not observed anymore for positive LNs (n ≤ 3) group. More importantly, multivariable analyses showed that the use of PORT is an independent risk factor of survival for positive LNs (n > 3) but not for positive LNs (n ≤ 3).
In Stage IIIA (pN2) NSCLC, the use of PORT demonstrated better survival results than no PORT for patients with positive LNs (n > 3), but not for patients with positive LNs (n ≤ 3).
Additional file 1: Table S1. Cox proportional hazards regression model for overall survival and lung cancer-specific survival in patients with stage IIIA pN2 status NSCLC. Abbreviations: NSCLC, Non-small cell lung cancer. NOS, Not Otherwise Specified. Table S2. Cox proportional hazards regression model for overall survival and lung cancer-specific survival in patients with stage IIIA pN2 status NSCLC. (No. of positive lymph nodes in two categories). Abbreviations: NSCLC, Non-small cell lung cancer. NOS, Not Otherwise Specified. Table S3. Baseline characteristics of Patients with NSCLC in overall survival analysis. *: 4, 5, 6, ≥7, these four categoric variables were designed for the right two columns. Abbreviations: NSCLC, Non-small cell lung cancer. NOS, Not Otherwise Specified. Table S4. Baseline characteristics of Patients with NSCLC in lung cancer-specific survival analysis. *: 4, 5, 6, ≥7, these four categoric variables were designed for the right two columns. Abbreviations: NSCLC, Non-small cell lung cancer. NOS, Not Otherwise Specified. (DOCX 68 kb)
Ramnath N, Dilling TJ, Harris LJ, Kim AW, Michaud GC, Balekian AA, Diekemper R, Detterbeck FC, Arenberg DA. Treatment of stage III non-small cell lung cancer: diagnosis and management of lung cancer: American College of Chest Physicians evidence-based clinical practice guidelines. CHEST Journal. 2013;143(5_suppl):e314S–40S. CrossRef
Group NM-aC. Adjuvant chemotherapy, with or without postoperative radiotherapy, in operable non-small-cell lung cancer: two meta-analyses of individual patient data. Lancet. 2010;375(9722):1267–77. CrossRef
Sawyer TE, Bonner JA, Gould PM, Foote RL, Deschamps C, Trastek VF, Pairolero PC, Allen MS, Lange CM, Li H. Effectiveness of postoperative irradiation in stage IIIA non–small cell lung cancer according to regression tree analyses of recurrence risks. Ann Thorac Surg. 1997;64(5):1402–7. CrossRefPubMed
Douillard J-Y, Rosell R, De Lena M, Riggi M, Hurteloup P, Mahe M-A, Association ANIT. Impact of postoperative radiation therapy on survival in patients with complete resection and stage I, II, or IIIA non–small-cell lung cancer treated with adjuvant chemotherapy: the adjuvant Navelbine international Trialist association (ANITA) randomized trial. Int J Radiat Oncol Biol Phys. 2008;72(3):695–701. CrossRefPubMed
Group PM-aT. Postoperative radiotherapy for non-small cell lung cancer. Cochrane Database Syst Rev. 2005;(2):CD002142.
Surmont V. Treatment advances in locally advanced and metastatic non-small cell. Lung Cancer. 2010. https://repub.eur.nl/pub/17725/.
Berardi R, Santinelli A, Brunelli A, Morgese F, Onofri A, Savini A, Caramanti M, Pompili C, Salati M, Zuccatosta L. Prognostic factors in early stage non-small cell lung cancer: the importance of number of Resected lymph nodes and vascular invasion. Chemotherapy: Open Access. 2013;2:120.
Robinson CG, Patel AP, Bradley JD, DeWees T, Waqar SN, Morgensztern D, Baggstrom MQ, Govindan R, Bell JM, Guthrie TJ, et al. Postoperative radiotherapy for pathologic N2 non-small-cell lung cancer treated with adjuvant chemotherapy: a review of the National Cancer Data Base. J Clin Oncol. 2015;33(8):870–6. CrossRefPubMedPubMedCentral
- Choice of postoperative radiation for stage IIIA pathologic N2 non-small cell lung cancer: impact of metastatic lymph node number
- BioMed Central
Neu im Fachgebiet Onkologie
Mail Icon II