Postoperative Radiotherapy and N2 Non-small Cell Lung Cancer Prognosis: A Retrospective Study Based on Surveillance, Epidemiology, and End Results Database

Yunbo Zhang; Liping Zheng; Junqi Liu; Jinqiu Li; Jianguang Zhang; Jingjing Ma; Yuxiu Song

doi:10.30564/jor.v3i2.3513

Postoperative Radiotherapy and N2 Non-small Cell Lung Cancer Prognosis: A Retrospective Study Based on Surveillance, Epidemiology, and End Results Database

Yunbo Zhang (Department of Oncology, Zibo Bashan Wanjie Hospital, Zibo, Shandong, 255213, China)
Liping Zheng (Department of Oncology, Zibo Bashan Wanjie Hospital, Zibo, Shandong, 255213, China)
Junqi Liu (Department of Radiotherapy, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, 450000, China)
Jinqiu Li (Department of Radiotherapy, The First Affiliated Hospital of Hebei North University, Zhangjiakou, Hebei, 075000, China)
Jianguang Zhang (Department of Oncology, Zibo Bashan Wanjie Hospital, Zibo, Shandong, 255213, China)
Jingjing Ma (Department of Oncology, Zibo Bashan Wanjie Hospital, Zibo, Shandong, 255213, China)
Yuxiu Song (Department of Oncology, Zibo Bashan Wanjie Hospital, Zibo, Shandong, 255213, China)

Article ID: 3513

Abstract

The purpose of this study is to clarify the significance of postoperative radiotherapy for N2 lung cancer. This study aimed to investigate the effect of postoperative radiotherapy on the survival and prognosis of patients with N2 lung cancer. Data from 12,000 patients with N2 lung cancer were extracted from the Surveillance, Epidemiology, and End Results database (2004-2012). Age at disease onset and 5-year survival rates were calculated. Survival curves were plotted using the Kaplan-Meier method. The univariate log-rank test was performed. Multivariate Cox regression were used to examine factors affecting survival. Patients’ median age was 67 years (mean 66.46 ± 10.03). The 5-year survival rate was 12.55%. Univariate analysis revealed age, sex, pathology, and treatment regimen as factors affecting prognosis. In multivariate analysis, when compared to postoperative chemotherapy, postoperative chemoradiotherapy was better associated with survival benefits (hazard ratio [HR]= 0.85, 95% confidence interval [CI]: 0.813-0.898, P <0.001). Propensity score matching revealed that patients who had received postoperative chemoradiotherapy had a better prognosis than did patients who had received postoperative chemotherapy (HR=0.869, 95% CI: 0.817-0.925, P <0.001). Female patients and patients aged <65 years had a better prognosis than did their counterparts. Patients with adenocarcinoma had a better prognosis than did patients with squamous cell carcinoma. Moreover, prognosis worsened with increasing disease T stage. Patients who had received postoperative chemoradiotherapy had a better prognosis than did patients who had received postoperative chemotherapy. Postoperative radiotherapy was an independent prognostic factor in this patient group.

Keywords

Non-small cell lung cancer; Radiotherapy; Postoperative; Prognosis

Full Text:

PDF

References

[1] Torre LA, Bray F, Siegel RL, Ferlay J, Lortet-Tieulent J, Jemal A. Global Cancer statistics, 2012. CA Cancer J Clin. 2015;65:87–108.

[2] Freddie Bray, BSc, MSc, Jacques Ferlay, ME，Isabelle Soerjomataram. Global Cancer Statistics 2018: GLOBOCAN Estimates of Incidence and Mortality Worldwide for 36 Cancers in 185 Countries. CA cancer J clin 2018;68: 394–424.

[3] Siegel RL,Miller KD,Jemal A.Cancer Statisitcs，2017.CA：Cancer J Clin.2017; 67: 7-30.

[4] Lam P,AuYeung KM,Cheng PW,et al. Correlating MRI and histologic tumor thickness in the assessment of oral tongue cancer.J. AJR Am J Roentgenol, 2004, 182(3): 803-808.

[5] Hiroaki Tsunezuka, Hiroaki Tsunezuka, Treatment rationale and design of the induction chemotherapy and adjuvant thoracic radiation in resectable N2-3A/3B non-small cell lung cancer (ICAT) study.J, Medicine.2019 Jul; 98(27) :e16298.

[6] Rosell R, Gomez-Codina J, Camps C, et al. A randomized trial comparing preoperative chemotherapy plus surgery with surgery alone in patients with non-small-cell lung cancer. N Engl J Med 1994; 330: 153–8.

[7] NSCLC Meta-analysis Collaborative GroupPreoperative chemotherapy for non-small-cell lung cancer: a systematic review and meta-analysis of individual participant data. Lancet 2014; 383: 1561–71.

[8] Farray D, Mirkovic N, Albain KS. Multimodality therapy for stage III non- small- cell lung cancer. J Clin Oncol. 2005;23(14): 3257‐3269.

[9] Willers H, Stinchcombe TE, Barriger RB, et al. ACR Appropriateness Criteria((R)) induction and adjuvant therapy for N2 nonsmall-cell lung cancer. Am J Clin Oncol 2015; 38: 197–205.

[10] Iwai H,Kyomoto R,HaKawa SK,et al. Magnetic resonance determination of tumor thickness as predictive factor of cervical metastasis in oral tongue carcinoma.J. Laryngoscope, 2002, 112(3): 457-461.

[11] NSCLC Meta-analyses Collaborative Group. Preoperative chemotherapy for nonsmall-cell lung cancer: a systematic review and meta-analysis of individual participant data. Lancet 2014; 383:1561–1571.

[12] Arriagada R, Auperin A, Burdett S, et al. Adjuvant chemotherapy, with or without postoperative radiotherapy, in operable nonsmall-cell lung cancer:two meta-analyses of individual patient data. Lancet 2010; 375: 1267–1277.

[13] Robinson CG, Patel AP, Bradley JD, DeWees T, Waqar SN, Morgensztern D, Baggstrom MQ, Govindan R, Bell JM, Guthrie TJ. 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; 33:870.

[14] Justin A. Drake, MD, David C. Portnoy, MD, Kurt Tauer, MD, et al. Adding Radiotherapy to Adjuvant Chemotherapy Does Not Improve Survival of Patients With N2 Lung Cancer.J. Ann Thorac Surg 2018; 106:959–65.

[15] Jonathan D. Spicer, Jitesh B. Shewale, BDS, David B. Nelson, et al.Multimodality Therapy for N2 Non-Small Cell Lung Cancer: An Evolving Paradigm.J.Ann Thorac Surg2019; 107: 277-84.

[16] Ramnath N, Dilling TJ, Harris LJ, et al. Treatment of stage III non-small cell lung cancer: diagnosis and management of lung cancer, 3rd ed: American College of Chest Physiciansevidence-based clinical practice guidelines. Chest 2013;143(5 Suppl) : e314S–40S.

[17] Brian E. Lally, Daniel Zelterman, Joseph M. Colasanto, et al. Postoperative Radiotherapy for Stage II or III Non–Small-Cell Lung Cancer Using the Surveillance, Epidemiology, and End Results Database.J. Journal of clinical oncology，2006. 19，24，2998-3006.

[18] Jean-Yves Douillard ，Rafael Rosell, Mario De Lena, et al. 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. Radiation Oncology Biol. Phys., 2008. 72, 3, 695–701.

[19] Alex Herskovic, Elizabeth Mauer, Paul Christos, Role of Postoperative Radiotherapy in Pathologic Stage IIIA (N2) Non–Small Cell Lung Cancer in a Prospective Nationwide Oncology Outcomes Database.J. Thorac Oncol. 2017 Feb;12(2): 302-313

[20] Rosenzweig K. Stereotactic Body Radiation Therapy as an Alternative to Surgery in Early-Stage Non-Small-Cell Lung Cancer. Oncology (Williston Park)2017; 31:492-8.

[21] Liyu Su, Mingqiu Chen,Huiyan Su, et al. Postoperative chemoradiotherapy is superior to postoperative chemotherapy alone in squamous cell lung cancer patients with limited N2 lymph node metastasis .J.BMC Cancer (2019) 19:1023.

DOI: https://doi.org/10.30564/jor.v3i2.3513

Refbacks

There are currently no refbacks.

This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.



Remember me