The impact of order with radiation therapy in stage IIIA pathologic N2 NSCLC patients: a population-based study
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RESEARCH ARTICLE
Open Access
The impact of order with radiation therapy in stage IIIA pathologic N2 NSCLC patients: a population-based study Hongxia Duan, Long Liang, Shuanshuan Xie* and Changhui Wang*
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, Survival, Radiotherapy, Surgery, SEER
Background Lung cancer is the leading cause of cancer-related mortality worldwide [1]. Lung cancer includes small cell lung cancer (SCLC) and non-small cell lung cancer (NSCLC), the major type of NSCLC are adenocarcinoma (AD) and squamous cell carcinoma (SQCC). In patients diagnosed with lung cancer, 15% are stage IIIA NSCLC [2–4], while stage IIIA pathologic N2 (IIIA/N2) account for * Correspondence: [email protected]; [email protected] Department of Respiratory Medicine, Shanghai Tenth People’s Hospital, Tongji University School of Medicine, #301, Mid Yanchang Rd, Shanghai 200072, China
50% of the locally advanced NSCLCs cases [5–7]. NSCL C patients in IIIA stage having a tumor size T1–T2 (T2: tumor > 3 cm and ≤ 5 cm) and M0 (without distant metastasis), along with ipsilateral mediastinal and/or subcarinal lymph node (N2), are diagnosed as IIIA/N2 NSCLC according to the 8th edition TNM Stage Classification [8]. N2 are classified into three different groups: occult N2, resectable N2, and non-resectable N2 [9]. Therefore, the optimal
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