Impact of locoregional recurrence versus distant metastasis on overall survival in patients with Non-Small cell lung cancer after Surgery: A secondary analysis of PORT-C RCT.
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引用次数: 0
Abstract
Purpose: The therapeutic advantage of postoperative radiation therapy (PORT) for non-small cell lung cancer (NSCLC) has not been shown to benefit overall survival (OS) according to two randomized controlled trials (RCTs), albeit an enhancement in locoregional-free survival was observed. We aimed to evaluate the relative influence of locoregional recurrence (LR) and distant metastasis (DM) on OS for patients with NSCLC after surgery.
Methods: This was a secondary analysis of PORT-C RCT. Patients with pN2 NSCLC undergoing complete resection followed by chemotherapy were included. A dynamic prediction model was developed to evaluate the impact of LR and DM on OS. The endpoint was OS. Age, sex, smoking history, histology, Karnofsky Performance Status, tumor side, T stage, and positive lymph node were baseline factors, whereas LR and DM status were time-dependent covariates.
Results: In total, 364 patients were eligible, including 214 and 150 in the non-PORT and PORT groups, respectively. DM significantly decreased OS in both the non-PORT (odds ratio [OR], 4.74; 95 % CI, 2.70-8.30; P < 0.01) and PORT (OR, 5.43; 95 % CI, 2.56-11.48; P < 0.01) groups. LR also significantly impacted OS in the non-PORT (OR, 2.09; 95 % CI, 1.12-3.93; P = 0.02) and the PORT (OR, 3.44; 95 % CI, 1.53-7.75; P < 0.01) groups. Multivariate Cox analysis identified the pT stage, positive lymph nodes, and histology as variables correlated with DM. A nomogram was developed to estimate the risk of DM. PORT did not significantly enhance OS in either the low (HR, 1.42; 95 % CI, 0.63-3.19, P = 0.40) or high-risk (HR, 0.62; 95 % CI, 0.35-1.09, P = 0.10) subgroup but in the medium-risk subgroup (HR, 0.20; 95 % CI, 0.05-0.86, P = 0.02).
Conclusion: DM and LR significantly impacted OS in patients with NSCLC after surgery. DM emerged as the dominant failure pattern, emphasizing more effective control of DM. PORT was beneficial for patients with a medium risk of DM.
期刊介绍:
Lung Cancer is an international publication covering the clinical, translational and basic science of malignancies of the lung and chest region.Original research articles, early reports, review articles, editorials and correspondence covering the prevention, epidemiology and etiology, basic biology, pathology, clinical assessment, surgery, chemotherapy, radiotherapy, combined treatment modalities, other treatment modalities and outcomes of lung cancer are welcome.