目的:尽管术后放疗(PORT)可以降低IIIA-N2非小细胞肺癌(NSCLC)患者的局部复发率,在手术治疗的IIIA-N2期非小细胞肺癌患者中,PORT对生存的作用仍存在争议.因此,本研究旨在评估PORT对手术治疗的IIIA-N2期非小细胞肺癌患者生存率的影响.
方法:本研究人群选自监测,流行病学,和结束结果数据库。Cox比例风险回归分析用于确定总生存期(OS)和癌症特殊生存期(CSS)结果的重要贡献者。为了平衡非PORT组和PORT组之间的基线特征,通过R软件进行倾向评分匹配(PSM)与1:1倾向最近邻匹配和0.001匹配耐受性.此外,使用Kaplan-Meier曲线可视化PORT组和非PORT组生存概率之间的OS和CSS.
结果:在所有评估病例中,4511与IIIA-N2非小细胞肺癌符合纳入条件,其中1920年加入了港口小组。在单变量分析和多变量分析中,性别,年龄,诊断年份,种族,组织学类型,T级,港口,使用化疗,在IIIA-N2NSCLC中,阳性区域节点与OS和CSS显着相关(P<0.05)。然而,在IIIA-N2NSCLC中,PORT与OS(单变量HR=0.92,95CI0.85-0.99,P=0.02;多变量HR=1.01,95CI0.93-1.08,P=0.91)和CSS(单变量HR=0.92,95CI0.85-1.01,P=0.06;多变量HR=1.10395CI0.94-1.12,P=0.56)无显著相关性。同时,在PSM之后,非PORT组和PORT组之间的OS和CSS均无显著差异(OSHR=1.08,95CI0.98-1.19,P=0.12;CSS=1.10,95CI0.99-1.23,P=0.07)。
结论:PORT对手术治疗的IIIA-N2期非小细胞肺癌患者的生存获益没有贡献。
OBJECTIVE: Although postoperative radiotherapy (PORT) could reduce the incidence of local recurrence in patients with IIIA-N2 non-small cell lung cancer (NSCLC), the role of PORT on survival in patients with surgically treated stage IIIA-N2 NSCLC remains controversial. Therefore, this study was designed to evaluate the effect of PORT on survival for patients with surgically treated stage IIIA-N2 NSCLC.
METHODS: This study population was chosen from the Surveillance, Epidemiology, and End Results database. The Cox proportional hazards regression analysis was used to determine significant contributors to overall survival (OS) and cancer special survival (CSS) outcomes. To balance baseline characteristics between the non-PORT group and PORT group, propensity score matching (PSM) with 1:1 propensity nearest-neighbor match by 0.001 matching tolerance was conducted by R software. Furthermore, a Kaplan-Meier curve was used to visualize the OS and CSS between the PORT group and non-PORT group survival probability.
RESULTS: Of all evaluated cases, 4511 with IIIA-N2 NSCLC were eligible for inclusion, of which 1920 were enrolled into the PORT group. On univariate analysis and multivariate analysis, sex, age, year of diagnosis, race, histologic type, T stage, PORT, use of chemotherapy, and positive regional nodes were significantly associated with OS and CSS in IIIA-N2 NSCLC (P < 0.05). However, PORT was not significantly associated with OS (univariate HR = 0.92, 95%CI 0.85-0.99, P = 0.02; multivariate HR = 1.01, 95%CI 0.93-1.08, P = 0.91) and CSS (univariate HR = 0.92, 95%CI 0.85-1.01, P = 0.06; multivariate HR = 1.103 95%CI 0.94-1.12, P = 0.56) in IIIA-N2 NSCLC. Meanwhile, after PSM, neither OS nor CSS did differ significantly between the non-PORT group and PORT group (OS HR = 1.08, 95%CI 0.98-1.19, P = 0.12; CSS HR = 1.10, 95%CI 0.99-1.23, P = 0.07).
CONCLUSIONS: PORT did not contribute to a survival benefit in patients with surgically treated stage IIIA-N2 NSCLC.