ⅢA/N2期非小细胞肺癌患者术后放疗的倾向评分匹配分析

Propensity Score Matching Analysis of Postoperative Radiotherapy in Patients with Stage ⅢA/N2 Non-Small Cell Lung Carcinoma

目的:采用倾向评分匹配(PSM)评估术后放疗在ⅢA/N2期非小细胞肺癌(NSCLC)患者中的作用。方法:从SEER数据库中收集外科手术切除联合辅助化疗的ⅢA/N2期NSCLC患者1832例,PSM平衡各变量,采用χ^(2)检验比较2组患者的基线特征、Kaplan-Meier曲线评估2组患者的总生存时间(OS)和肺癌特异性生存期(LCSS)、COX回归模型分析预后因素。结果:在1832例患者中,行术后放疗患者906例(纳入术后放疗组),未行术后放疗患者926例(纳入对照组),2组患者经PSM后其OS和LCSS差异无统计学意义(P>0.05);单因素COX回归分析结果显示,年龄<65岁、女性、临床分期Ⅰ~Ⅱ期、肿瘤直径≤3 cm是生存预后保护性因素(HR<1,P<0.05);多因素COX回归分析结果显示,年龄<65岁、淋巴结清扫数量≥4个能更好地预测患者的OS和LCSS(HR<1,P<0.05);在术后放疗亚组中,肺鳞癌和年龄<65岁患者的LCSS更差。结论:手术切除联合辅助化疗的ⅢA/N2期NSCLC患者加用术后放疗并不能改善其预后。

Objective:Propensity score matching(PSM)was used to evaluate the effect of postoperative radiotherapy in patients with stageⅢA/N2 non-small cell lung carcinoma(NSCLC).Methods:A total of 1832 patients with stageⅢA/N2 NSCLC undergoing surgical resection combined with adjuvant chemotherapy were collected from the SEER database.Baseline characteristics of the two groups were compared by χ^(2) test,overall survival(OS)and lung cancer-specific survival(LCSS)of the two groups were evaluated by Kaplan-Meier curve,and prognostic factors were analyzed by COX regression model.Results:Among the 1832 patients,906 patients received postoperative radiotherapy(included in the postoperative radiotherapy group)and 926 patients did not receive postoperative radiotherapy(included in the control group).There was no statistical significance in OS and LCSS between the two groups after PSM(P>0.05).Univariate COX regression analysis showed that age<65 years old,female,clinical stageⅠ-Ⅱ,tumor diameter≤3 cm were protective factors for survival and prognosis(HR<1,P<0.05).Multivariate COX regression analysis showed that age<65 years old,number of lymph node dissection≥4 could better predict OS and LCSS(HR<1,P<0.05).In the postoperative radiotherapy subgroup,patients with squamous cell carcinoma and age<65 years had worse LCSS.Conclusion:The addition of postoperative radiotherapy did not improve the prognosis of stageⅢA/N2 NSCLC patients treated with surgical resection combined with adjuvant chemotherapy.