术后辅助放疗对N2期非小细胞肺癌患者预后的影响

The effect of adjuvant radiotherapy on N2 patients with non-small cell lung cancer

目的探讨术后辅助放疗对N2期行肺癌根治术的非小细胞肺癌(NSCLC)患者预后的影响。方法将美国SEER数据库2004-2016年间收录的接受肺癌根治术联合化疗或术后辅助放化疗的N2期1208例非小细胞肺癌患者资料纳入研究,其中接受肺癌根治术联合化疗的有627例(手术+化疗组),接受肺癌根治术联合放化疗的有581例(手术+放化疗组)。分析并比较术后辅助放疗对N2期行肺癌根治术的非小细胞肺癌患者预后的影响,同时采用1:1倾向性匹配方法分析两组患者预后情况。结果纳入研究的两组N2期非小细胞肺癌患者中,手术+放化疗组患者中位生存期为51月,3年、5年肿瘤特异性生存分别为58.3%、44.9%;手术+化疗组患者中位生存期为50月,3年、5年肿瘤特异性生存分别为59.9%、46.5%;两组患者的肿瘤特异性生存差异无统计学意义(P>0.05);亚组分析发现,T1期患者中手术+放化疗组的特异性生存明显差于手术+化疗组(χ^2=5.085,P<0.05);多因素Cox回归分析提示,年龄、性别、G分期、T分期及淋巴结转移数目是影响N2期非小细胞肺癌患者肿瘤特异性生存的重要因素(Wald=15.236、7.039、4.841、10.155、11.192,P<0.05)。倾向性评分匹配两组N2期非小细胞肺癌患者后分析发现,手术+放化疗组与手术+化疗组的肿瘤特异性生存差异无统计学意义(P>0.05);而T1期NSCLC患者中手术+放化疗组的特异性生存明显差于手术+化疗组(χ^2=5.364,P<0.05),而T3~4期的亚组手术+放化疗组的肿瘤特异性生存明显优于手术+化疗组(χ^2=4.486,P<0.05);针对病理亚组倾向性匹配后发现,非腺癌亚组中手术+放化疗组的肿瘤特异性生存亦明显优于手术+化疗组(χ^2=6.279,P<0.05)。多因素Cox回归分析也提示,术后放疗的加入是影响N2期肺非腺癌患者肿瘤特异性生存的重要因素(Wald=7.300,P<0.05);但肺腺癌亚组患者倾向性匹配后手术+放化疗组与手术+化疗组肿瘤特异性生存之间差异无统计学意义(P>0.05)。结论术后辅助放疗能够改善T3~4期或者非腺癌N2期非小细胞肺癌患者的预后。而对T1期术后辅助放疗选择仍需谨慎。

Objective To investigate the effect of adjuvant radiotherapy on the prognosis of patients with N2 stage non-small cell lung cancer(NSCLC)undergoing radical resection.Methods The data of 1208 patients with NSCLC who received radical lung cancer resection combined with chemotherapy or post-operative adjuvant radiotherapy and chemotherapy from SEER database of the United States from 2004 to 2016 were included in the study.627 patients received radical lung cancer resection combined with chemotherapy(surgery+chemotherapy group),and 581 patients received radical lung cancer resection combined with radiochemotherapy(surgery+radiochemotherapy group).We analyzed and compared the effect of postoperative adjuvant radiotherapy on the prognosis of patients with N2 stage NSCLC undergoing radical resection.The 1:1 propensity matching method was used to analyze the prognosis of the two groups.Results In the two groups of patients with stage N2 NSCLC included in the study,the median survival time was 51 months in the operation+radiotherapy and chemotherapy group,and the 3-and 5-year cancer specific survival rates were 58.3%and 44.9%,respectively.The median survival time was 50 months in operation+chemotherapy group,and the 3-and 5-year cancer specific survival rates were 59.9%and 46.5%,respectively.There was no statistically significant difference between the two groups in cancer specific survival(P>0.05).The result of subgroup analysis showed that the cancer specific survival of patients in operation+radiotherapy and chemotherapy group was significantly worse than that in operation+chemotherapy group(χ^2=5.085,P<0.05).Multivariate Cox regression analysis showed that age,gender,G stage,T stage and the number of lymph node metastasis were the important factors affecting the cancer specific survival of patients with N2 NSCLC(Wald=15.236,7.039,4.841,10.155,11.192,respectively,P<0.05).After propensity matching,there was no statistically significant difference in cancer specific survival(P>0.05)between the two groups.However,in the T1 NSCLC patients,the cancer specific survival of operation+radiochemotherapy group was significantly worse than that of operation+chemotherapy group(χ^2=5.364,P<0.05),while the cancer specific survival of operation+radiochemotherapy group was significantly better than that of operation+chemotherapy group in T3-4 subgroup(χ^2=4.486,P<0.05).According to the tendency matching of pathological subgroups,the cancer specific survival of surgery+radiochemotherapy group was significantly better than that of surgery+chemotherapy group(χ^2=6.279,P<0.05)in the non adenocarcinoma subgroup.And the multivariate Cox regression analysis indicated that postoperative radiotherapy was an important factor for cancer specific survival in patients with N2 non adenocarcinoma non-small cell lung cancer(Wald=7.300,P<0.05).However,before and after propensity matching in lung adenocarcinoma subgroup,there was no statistically significant difference in cancer specific survival between the surgery+radiochemotherapy group and the surgery+chemotherapy group(P>0.05).Conclusions Postoperative adjuvant radiotherapy can improve the prognosis of patients with T3-4 or non-adenocarcinoma N2 NSCLC.But,for other patients with N2 non-small cell lung cancer,the choice of postoperative adjuvant radiotherapy should be cautious,especially for T1 stage.