完全切除的病理分期 IIIA（N2）非小细胞肺癌患者术后放疗有效吗？高危人群应考虑

IF 2.7 3区医学 Q3 ONCOLOGY

Clinical and Translational Radiation Oncology Pub Date : 2024-11-17 DOI:10.1016/j.ctro.2024.100889

Shu-Xian Zhang , Chen-Chen Zhang , Run-Ping Hou , Xu-Wei Cai , Jun Liu , Wen Yu , Qin Zhang , Jin-Dong Guo , Chang-Lu Wang , Hong-Xuan Li , Zheng-Fei Zhu , Xiao-Long Fu , Wen Feng

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引用次数: 0

摘要

背景和目的我们旨在评估术后放疗（PORT）对完全切除的病理IIIA（N2）期非小细胞肺癌（NSCLC）患者的益处，这些患者具有较高的局部复发（LRR）风险。材料和方法自2016年7月起开展了一项前瞻性随机试验，以探索完全切除的IIIA（N2）期NSCLC高LRR风险患者PORT的最佳时机（NCT02974426）。患者通过预后指数（PI）模型被确定为高LRR风险患者，并随机分配到PORT-first或PORT-last治疗。为评估高 LRR 风险患者的 PORT 治疗效果，该试验中的所有患者构成 PORT 队列，而未接受 PORT 治疗的高 LRR 风险患者则从回顾性队列中选出，作为非 PORT 队列。进行倾向评分匹配（PSM）分析，比较总生存期（OS）、无病生存期（DFS）、无局部复发生存期（LRFS）和无远处转移生存期（DMFS）。结果2016年至2022年间，共有132名患者纳入试验，中位随访时间为49.3个月。3年OS率为83.2%，3年DFS率为35.0%。其中，122 名患者（92%）接受了计划的 PORT 治疗。对于 132 例意向治疗患者，通过与非 PORT 患者队列（n = 307）进行 PSM 分析，得出 130 对匹配患者。结果显示，PORT 改善了 LRFS（3 年 LRFS，77.6 % vs. 57.3 %；p = 0.00014）、DFS（3 年 DFS，35.2 % vs. 28.6 %；p = 0.038）和 OS（3 年 OS，83.0 % vs. 60.结论PORT可以增加完全切除的IIIA（N2）NSCLC高LRR风险患者的局部控制、DFS和OS。未来的研究应利用多维数据更精确地确定受益于PORT的亚组，并通过前瞻性试验验证这些发现。

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Is postoperative radiotherapy effective in patients with completely resected pathologic stage IIIA(N2) non-small cell lung cancer? High-risk populations should consider it

Background and purpose

We aimed to assess the benefits of postoperative radiotherapy (PORT) in completely resected patients with pathologic stage IIIA(N2) non-small cell lung cancer (NSCLC) with a high risk of locoregional recurrence (LRR).

Materials and methods

A prospective, randomized trial was conducted starting in July 2016 to explore the optimal timing of PORT in high-LRR-risk patients with completely resected IIIA(N2) NSCLC (NCT02974426). Patients were identified as high-LRR-risk patients via the prognostic index (PI) model and were randomly assigned to PORT-first or PORT-last treatment. To evaluate PORT for high-LRR-risk patients, all patients in this trial constituted the PORT cohort, whereas high-LRR-risk patients without PORT were selected from a retrospective cohort as the non-PORT cohort. Propensity score-matched (PSM) analyses were conducted to compare overall survival (OS), disease-free survival (DFS), locoregional recurrence-free survival (LRFS) and distant metastasis-free survival (DMFS).

Results

Between 2016 and 2022, 132 patients were included in the trial, with a median follow-up of 49.3 months. The 3-year OS rate was 83.2 %, and the 3-year DFS rate was 35.0 %. Among these patients, 122 patients (92 %) received planned PORT. For 132 intention-to-treat patients, PSM analysis with the non-PORT cohort (n = 307) resulted in 130 matched pairs. The results revealed that PORT improved LRFS (3-year LRFS, 77.6 % vs. 57.3 %; p = 0.00014), DFS (3-year DFS, 35.2 % vs. 28.6 %; p = 0.038), and OS (3-year OS, 83.0 % vs. 60.7 %; p = 0.00017), with no difference in DMFS (p = 0.17).

Conclusion

PORT could increase local control, DFS, and OS in high-LRR-risk patients with completely resected IIIA(N2) NSCLC. Future research should utilize multidimensional data to pinpoint more precise subgroups benefiting from PORT, with prospective trials validating these findings.

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