局部复发与远处转移对非小细胞肺癌术后患者总生存率的影响：PORT-C RCT的二次分析

IF 4.5 2区医学 Q1 ONCOLOGY

Lung Cancer Pub Date : 2025-01-01 DOI:10.1016/j.lungcan.2024.108063

Zeliang Ma , Yunsong Liu , Yongxing Bao , Meiqi Wang , Xu Yang , Yu Men , Jianyang Wang , Lei Deng , Yirui Zhai , Chen Hu , Nan Bi , Luhua Wang , Zhouguang Hui

{"title":"局部复发与远处转移对非小细胞肺癌术后患者总生存率的影响：PORT-C RCT的二次分析","authors":"Zeliang Ma , Yunsong Liu , Yongxing Bao , Meiqi Wang , Xu Yang , Yu Men , Jianyang Wang , Lei Deng , Yirui Zhai , Chen Hu , Nan Bi , Luhua Wang , Zhouguang Hui","doi":"10.1016/j.lungcan.2024.108063","DOIUrl":null,"url":null,"abstract":"<div><h3>Purpose</h3><div>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.</div></div><div><h3>Methods</h3><div>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.</div></div><div><h3>Results</h3><div>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).</div></div><div><h3>Conclusion</h3><div>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.</div></div>","PeriodicalId":18129,"journal":{"name":"Lung Cancer","volume":"199 ","pages":"Article 108063"},"PeriodicalIF":4.5000,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"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\",\"authors\":\"Zeliang Ma , Yunsong Liu , Yongxing Bao , Meiqi Wang , Xu Yang , Yu Men , Jianyang Wang , Lei Deng , Yirui Zhai , Chen Hu , Nan Bi , Luhua Wang , Zhouguang Hui\",\"doi\":\"10.1016/j.lungcan.2024.108063\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<div><h3>Purpose</h3><div>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.</div></div><div><h3>Methods</h3><div>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.</div></div><div><h3>Results</h3><div>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).</div></div><div><h3>Conclusion</h3><div>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.</div></div>\",\"PeriodicalId\":18129,\"journal\":{\"name\":\"Lung Cancer\",\"volume\":\"199 \",\"pages\":\"Article 108063\"},\"PeriodicalIF\":4.5000,\"publicationDate\":\"2025-01-01\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Lung Cancer\",\"FirstCategoryId\":\"3\",\"ListUrlMain\":\"https://www.sciencedirect.com/science/article/pii/S016950022400597X\",\"RegionNum\":2,\"RegionCategory\":\"医学\",\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"\",\"PubModel\":\"\",\"JCR\":\"Q1\",\"JCRName\":\"ONCOLOGY\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Lung Cancer","FirstCategoryId":"3","ListUrlMain":"https://www.sciencedirect.com/science/article/pii/S016950022400597X","RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q1","JCRName":"ONCOLOGY","Score":null,"Total":0}

引用次数: 0

摘要

目的：根据两项随机对照试验（rct），尽管观察到局部区域无生存期的增强，但未显示非小细胞肺癌（NSCLC）术后放射治疗（PORT）的治疗优势有利于总生存期（OS）。我们旨在评估局部复发（LR）和远处转移（DM）对非小细胞肺癌术后OS的相对影响。方法：这是PORT-C随机对照试验的二次分析。pN2 NSCLC患者接受完全切除和化疗。建立了一个动态预测模型来评估LR和DM对OS的影响。终点为OS。年龄、性别、吸烟史、组织学、Karnofsky Performance Status、肿瘤一侧、T分期和阳性淋巴结是基线因素，而LR和DM状态是随时间变化的协变量。结果：共有364例患者符合条件，其中非PORT组214例，PORT组150例。DM显著降低了非port患者的OS(优势比[OR]， 4.74；95% ci, 2.70-8.30；结论：DM和LR对非小细胞肺癌术后OS有显著影响。糖尿病成为主要的失败模式，强调更有效地控制糖尿病。PORT对糖尿病中度风险的患者是有益的。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

查看原文本刊更多论文

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

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.

求助全文

通过发布文献求助，成功后即可免费获取论文全文。去求助

来源期刊

Lung Cancer 医学-呼吸系统

CiteScore

9.40

自引率

3.80%

发文量

407

审稿时长

25 days

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.