Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Comparative Study
. 2020 Aug 26;20(1):809.
doi: 10.1186/s12885-020-07309-y.

The impact of order with radiation therapy in stage IIIA pathologic N2 NSCLC patients: a population-based study

Hongxia Duan  1 , Long Liang  1 , Shuanshuan Xie  2 , Changhui Wang  3
Affiliations
Comparative Study

The impact of order with radiation therapy in stage IIIA pathologic N2 NSCLC patients: a population-based study

Hongxia Duan et al. BMC Cancer. .

Abstract

Background: The aim of this study was to investigate the optimal order of radiation therapy in patients affected by stage IIIA pathologic N2 (IIIA/N2) non-small-cell lung cancer (NSCLC) and to identify its potential risk factors.

Methods: 17,654 (8786 men and 8868 women) diagnosed with NSCLC stage IIIA-N2 from 2004 to 2015 patients were identified in the Surveillance, Epidemiology, and End Results (SEER) database. Among the relevant clinical parameters, we evaluated overall survival (OS), lung cancer-specific survival (LCSS) and other variables such as age, sex and tumor size in patients who were treated with different combinations of surgery and radiotherapy strategies.

Results: We discovered that surgery benefit in younger IIIA/N2 NSCLC patients (age ≤ 75), and compared with surgery only, preoperative radiotherapy significantly improved the survival rate most (p < 0.001). When we performed the OS and LCSS analysis in the subgroup of patients' age > 75 years old, who underwent postoperative radiotherapy (PORT) had the highest survival rate (p < 0.001). Multivariate analyses showed that the following parameters had a negative impact on survival: female sex, older age, no chemotherapy, large tumor size, high tumor grade, no surgery or radiotherapy.

Conclusions: In IIIA/N2 NSCLC patients, surgery, radiotherapy and chemotherapy were associated with improved OS and LCSS. Younger patients underwent surgical resection and chemotherapy, the main population we studied, benefited most from preoperative radiotherapy in all orders with radiation therapy (p < 0.001). In patients more than 75 years old, there was no clear benefit from only surgery, and PORT was recommended in case of having surgery.

Keywords: Non-small-cell lung carcinoma; Radiotherapy; SEER; Surgery; Survival.

PubMed Disclaimer

Conflict of interest statement

The authors declare no potential conflicts of interest related to this study.

Figures

Fig. 1
Fig. 1
Patient selection for this study
Fig. 2
Fig. 2
Number of IIIA/N2 NSCLC patients underwent preoperative radiotherapy and PORT from 2004 to 2015. There were 241, 216, 195 IIIA/N2 NSCLC patients received preoperative radiotherapy with surgery in 2004–2007, 2008–2011 and 2012–2017, respectively. Whereas, the number of IIIA/N2 NSCLC patients who underwent PORT with surgery were 1105, 1326, 1775 in the same time periods as above. Abbreviations: NSCLC, non-small cell lung cancer; IIIA/N2, stage IIIA pathologic N2; PORT, postoperative radiotherapy
Fig. 3
Fig. 3
Kaplan–Meier analysis of different radiotherapy sequences on OS and LCSS of IIIA/N2 NSCLC patients. It showed that both in OS and LCSS of IIIA/N2 NSCLC patients, preoperative radiotherapy was the best strategy, and then were both preoperative and PORT, PORT, only surgery and neither surgery nor radiotherapy. Log Rank p < 0.001. The number of patients at risk in different time periods was under survival curves. Abbreviations: NSCLC, non–small cell lung cancer; IIIA/N2, stage IIIA pathologic N2; OS, Overall survival; LCSS, Lung cancer specific survival
Fig. 4
Fig. 4
The OS curves in IIIA/N2 NSCLC subgroups with different surgery and radiotherapy combination. Log Rank p < 0.001 each subgroup. In subgroup age > 75, p- value of the OS of patients treated by preoperative radiotherapy compared to patients who underwent PORT was 0.6848. Each p-value < 0.05 in the pairwise comparison of other subgroups. Abbreviations: NSCLC, non-small cell lung cancer; IIIA/N2, stage IIIA pathologic N2; OS, Overall survival; PORT, postoperative radiotherapy. The number of patients at risk in different time periods was in Supplementary Table 1
Fig. 5
Fig. 5
The LCSS curves in IIIA/N2 NSCLC subgroups with different surgery and radiotherapy combination. Log Rank p < 0.001 in each subgroup. p-value of the lung cancer-specific survival of patients treated by preoperative radiotherapy compared to patients who underwent PORT was 0.5293. Each p value < 0.05 in the pairwise comparison of other subgroups. The number of patients at risk in different time periods was in Supplementary Table 1. Abbreviations: NSCLC, non-small cell lung cancer; IIIA/N2, stage IIIA pathologic N2; LCSS, Lung cancer-specific survival; PORT, postoperative radiotherapy
See this image and copyright information in PMC

References

    1. Siegel R, Ma J, Zou Z, Jemal A. Cancer statistics, 2014. CA Cancer J Clin. 2014;64(1):9–29. doi: 10.3322/caac.21208. - DOI - PubMed
    1. Mountain CF. Staging classification of lung cancer. A critical evaluation. Clin Chest Med. 2002;23(1):103–121. doi: 10.1016/S0272-5231(03)00063-7. - DOI - PubMed
    1. Sawabata N, Miyaoka E, Asamura H, Nakanishi Y, Eguchi K, Mori M, Nomori H, Fujii Y, Okumura M, Yokoi K, R. Japanese Joint Committee for Lung Cancer Japanese lung cancer registry study of 11,663 surgical cases in 2004: demographic and prognosis changes over decade. J Thorac Oncol. 2011;6(7):1229–1235. doi: 10.1097/JTO.0b013e318219aae2. - DOI - PubMed
    1. Siegel RL, Miller KD, Jemal A. Cancer statistics, 2017. CA Cancer J Clin. 2017;67(1):7–30. doi: 10.3322/caac.21387. - DOI - PubMed
    1. Zeng X, Karnon J, Wang S, Wu B, Wan X, Peng L. The cost of treating advanced non-small cell lung cancer: estimates from the chinese experience. PLoS One. 2012;7(10):e48323. doi: 10.1371/journal.pone.0048323. - DOI - PMC - PubMed

Publication types

MeSH terms