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. 2022 Feb;13(3):404-411.
doi: 10.1111/1759-7714.14273. Epub 2021 Dec 14.

Postoperative radiotherapy improves survival of patients with ypN2 non-small cell lung cancer after neoadjuvant chemotherapy followed by surgery - A propensity score matching study of the Surveillance, Epidemiology, and End Results database

Yongxing Bao  1 , Xu Yang  1 , Yu Men  1   2 , Jingjing Kang  3 , Xin Sun  1 , Maoyuan Zhao  1 , Shuang Sun  1 , Meng Yuan  1 , Zeliang Ma  1 , Zhouguang Hui  1   2
Affiliations

Postoperative radiotherapy improves survival of patients with ypN2 non-small cell lung cancer after neoadjuvant chemotherapy followed by surgery - A propensity score matching study of the Surveillance, Epidemiology, and End Results database

Yongxing Bao et al. Thorac Cancer. 2022 Feb.

Abstract

Background: For patients with ypN2 non-small cell lung cancer (NSCLC) after neoadjuvant chemotherapy followed by surgery (NCS), the role of postoperative radiotherapy (PORT) is unclear. The aim of our study was to evaluate the effect of PORT on survival of ypN2 NSCLC patients after NCS.

Methods: Between 2004 and 2015, patients with ypN2 NSCLC after NCS were filtrated from the Surveillance, Epidemiology, and End Results (SEER) database. Propensity score matching (PSM) was used to balance the baseline characteristics of the PORT and non-PORT groups. Kaplan-Meier method and Cox proportional hazards models were adopted to estimate overall survival (OS) and cancer-specific survival (CSS).

Results: A total of 257 patients who met the criteria were included in the study. After PSM, 115 patients remained in each group. The survival of patients in the PORT group was significantly better than those in the non-PORT group. Median OS was 36 months vs. 26 months, and 5-year OS rate was 40.5% vs. 21.0% (p = 0.002). The median CSS was 38 months vs. 27 months, and the 5-year CSS rate was 43.7% vs. 22.1% (p < 0.001). Multivariable analysis showed that PORT was an independent prognostic factor for OS (HR = 0.59, 95% CI: 0.43-0.82, p = 0.001) and CSS (HR = 0.56, 95% CI: 0.41-0.78, p = 0.001). Subgroup analysis showed that patients in the following subgroups could benefit from PORT: age ≤ 70, diagnosed in the later period (2010-2015), white race, squamous cell carcinoma, grade III-IV, lobectomy, stage T3-4, or with positive regional nodes ≤3 or > 3.

Conclusions: For patients with ypN2 NSCLC after NCS, PORT significantly improves OS and CSS. These results need to be confirmed by further randomized studies.

Keywords: NSCLC; PORT; SEER database; neoadjuvant chemotherapy; ypN2.

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Conflict of interest statement

None.

Figures

FIGURE 1
FIGURE 1
Patient selection
FIGURE 2
FIGURE 2
Survival curves according to the use of PORT before and after PSM. (a) OS curves before PSM. (b) OS curves after PSM. (c) CSS curves before PSM. (d) CSS curves after PSM
FIGURE 3
FIGURE 3
Multivariable analysis of predictors for OS and CSS after PSM. (a) Multivariable analysis of predictors for OS. (b) Multivariable analysis of predictors for CSS
FIGURE 4
FIGURE 4
Subgroup analysis of PORT or non‐PORT for OS after PSM
FIGURE 5
FIGURE 5
Subgroup analysis of PORT or non‐PORT for CSS after PSM
See this image and copyright information in PMC

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