Abstract：
BACKGROUND: Neoadjuvant chemoimmunotherapy followed by surgery is recommended for resectable non-small-cell lung cancer (NSCLC). However, a considerable proportion of patients do not undergo surgery and opt for alternative treatments such as radiotherapy. The efficacy of radiotherapy in this context remains unclear.
METHODS: This retrospective study analyzed data from patients with stage III NSCLC who received neoadjuvant chemoimmunotherapy followed by either surgery or radiotherapy. Propensity score matching (PSM) was used to balance the heterogeneity between the groups. Efficacy outcomes, safety profiles, and disease recurrence patterns were assessed.
RESULTS: In total, 175 patients were included; 50 underwent radiotherapy, and 125 underwent surgery. Prior to matching, radiotherapy was inferior to surgery in terms of progression-free survival (PFS; Hazard ratio [HR], 2.23; P = 0.008). Following a 1:1 PSM adjustment, each group consisted of 40 patients. The median PFS was 30.8 months in the radiotherapy group and not reached in the surgery group (HR, 1.46; P = 0.390). The 12- and 24-month PFS rates were 90.4 % and 69.0 % for the radiotherapy group compared to 94.1 % and 73.9 % for the surgery group, respectively. Subgroup analyses after PSM showed that patients with stage IIIA disease tend to benefit more from surgery than those with stage IIIB disease (HR, 3.00; P = 0.074). Grade 3-4 treatment-related adverse events (TRAEs) occurred in 62.5 % of patients in the radiotherapy group and 55.0 % in the surgery group, with no grade 5 TRAEs reported. The incidence of grade 3-4 treatment-related pneumonitis or pneumonia was 7.5 % and 2.5 % in the radiotherapy and surgery groups, respectively.
CONCLUSIONS: Radiotherapy may be a viable alternative to surgery in patients with resectable NSCLC who do not undergo surgical resection after initial neoadjuvant chemoimmunotherapy, offering comparable efficacy and a manageable safety profile. Larger prospective studies are needed to validate these findings and optimize the treatment strategies for this patient population.
METHODS: This retrospective study analyzed data from patients with stage III NSCLC who received neoadjuvant chemoimmunotherapy followed by either surgery or radiotherapy. Propensity score matching (PSM) was used to balance the heterogeneity between the groups. Efficacy outcomes, safety profiles, and disease recurrence patterns were assessed.
RESULTS: In total, 175 patients were included; 50 underwent radiotherapy, and 125 underwent surgery. Prior to matching, radiotherapy was inferior to surgery in terms of progression-free survival (PFS; Hazard ratio [HR], 2.23; P = 0.008). Following a 1:1 PSM adjustment, each group consisted of 40 patients. The median PFS was 30.8 months in the radiotherapy group and not reached in the surgery group (HR, 1.46; P = 0.390). The 12- and 24-month PFS rates were 90.4 % and 69.0 % for the radiotherapy group compared to 94.1 % and 73.9 % for the surgery group, respectively. Subgroup analyses after PSM showed that patients with stage IIIA disease tend to benefit more from surgery than those with stage IIIB disease (HR, 3.00; P = 0.074). Grade 3-4 treatment-related adverse events (TRAEs) occurred in 62.5 % of patients in the radiotherapy group and 55.0 % in the surgery group, with no grade 5 TRAEs reported. The incidence of grade 3-4 treatment-related pneumonitis or pneumonia was 7.5 % and 2.5 % in the radiotherapy and surgery groups, respectively.
CONCLUSIONS: Radiotherapy may be a viable alternative to surgery in patients with resectable NSCLC who do not undergo surgical resection after initial neoadjuvant chemoimmunotherapy, offering comparable efficacy and a manageable safety profile. Larger prospective studies are needed to validate these findings and optimize the treatment strategies for this patient population.
摘要：
背景：对于可切除的非小细胞肺癌（NSCLC），推荐新辅助化学免疫疗法和手术治疗。然而,相当比例的患者没有接受手术，而是选择替代治疗，如放疗。放疗在这种情况下的疗效尚不清楚。
方法：这项回顾性研究分析了III期NSCLC患者的数据，这些患者接受了新辅助化学免疫疗法以及手术或放疗。使用倾向评分匹配(PSM)来平衡组间的异质性。疗效结果，安全概况,并评估疾病复发模式。
结果：总计，纳入175例患者；50例接受放疗，125人接受了手术。在匹配之前，在无进展生存期方面，放疗不如手术(PFS；危险比[HR]，2.23；P=0.008）。在1:1PSM调整后，每组40例患者.放疗组中位PFS为30.8个月,手术组未达到(HR,1.46；P=0.390）。放疗组12个月和24个月的PFS分别为90.4%和69.0%，手术组为94.1%和73.9%，分别。PSM后的亚组分析表明，IIIA期疾病的患者比IIIB期疾病的患者从手术中受益更多（HR，3.00；P=0.074）。3-4级治疗相关不良事件(TRAEs)发生在放疗组的62.5%和手术组的55.0%,没有5级TRAE报告。放疗组和手术组3-4级治疗相关性肺炎或肺炎的发生率分别为7.5%和2.5%,分别。
结论：对于初次新辅助化学免疫疗法后未接受手术切除的可切除非小细胞肺癌患者，放射治疗可能是一种可行的替代手术方法。提供相当的疗效和可控的安全性。需要更大的前瞻性研究来验证这些发现并优化该患者人群的治疗策略。
方法：这项回顾性研究分析了III期NSCLC患者的数据，这些患者接受了新辅助化学免疫疗法以及手术或放疗。使用倾向评分匹配(PSM)来平衡组间的异质性。疗效结果，安全概况,并评估疾病复发模式。
结果：总计，纳入175例患者；50例接受放疗，125人接受了手术。在匹配之前，在无进展生存期方面，放疗不如手术(PFS；危险比[HR]，2.23；P=0.008）。在1:1PSM调整后，每组40例患者.放疗组中位PFS为30.8个月,手术组未达到(HR,1.46；P=0.390）。放疗组12个月和24个月的PFS分别为90.4%和69.0%，手术组为94.1%和73.9%，分别。PSM后的亚组分析表明，IIIA期疾病的患者比IIIB期疾病的患者从手术中受益更多（HR，3.00；P=0.074）。3-4级治疗相关不良事件(TRAEs)发生在放疗组的62.5%和手术组的55.0%,没有5级TRAE报告。放疗组和手术组3-4级治疗相关性肺炎或肺炎的发生率分别为7.5%和2.5%,分别。
结论：对于初次新辅助化学免疫疗法后未接受手术切除的可切除非小细胞肺癌患者，放射治疗可能是一种可行的替代手术方法。提供相当的疗效和可控的安全性。需要更大的前瞻性研究来验证这些发现并优化该患者人群的治疗策略。
