Choice of postoperative radiation for stage IIIA pathologic N2 non-small cell lung cancer: impact of metastatic lymph node number

Siwei Wang,Xiangbao Yang,Mantang Qiu,Lin Xu,Rui Chen,Wenjia Xia,Yajing Wang,Keping Xu,Feng Jiang,Zhifei Ma,Youtao Xu,Rong Yin

doi:10.1186/s13014-017-0946-1

Abstract

BackgroundPostoperative radiation (PORT) is an option for non-small cell lung cancer (NSCLC) patients with resectable stage IIIA pathological N2 status (pN2). For patients with PORT, this study aims to investigate the impact of the exact number of positive lymph nodes (LNs) on overall survival (OS) and lung cancer-specific survival (LCSS).MethodsWithin the Surveillance, Epidemiology, and End Results database, we identified 3373 patients with stage IIIA pathological N2 status (pN2) NSCLC who underwent a lobectomy or pneumonectomy from 2004 to 2013. OS and LCSS were compared among patients coded as receiving PORT or observation. The proportional hazards model was applied for investigation.ResultsOS and LCSS favored PORT for patients with stage IIIA (pN2) NSCLC. Multivariable analyses showed that PORT and the exact number of positive LNs (n ≤ 3) were independently associated with better OS and LCSS. Both better OS and LCSS emerged for positive LNs (n > 3) after the use of PORT in survival analyses, whereas the benefits of OS and LCSS were not observed anymore for positive LNs (n ≤ 3) group. More importantly, multivariable analyses showed that the use of PORT is an independent risk factor of survival for positive LNs (n > 3) but not for positive LNs (n ≤ 3).ConclusionsIn Stage IIIA (pN2) NSCLC, the use of PORT demonstrated better survival results than no PORT for patients with positive LNs (n > 3), but not for patients with positive LNs (n ≤ 3).

Highlights

Postoperative radiation (PORT) is an option for non-small cell lung cancer (NSCLC) patients with resectable stage IIIA pathological N2 status
Baseline characteristics and outcomes A total of 3377 stage IIIA (N2) NSCLC patients with positive lymph nodes (LNs) were included in overall survival analysis, and 3077 patients were included in lung cancer-specific survival analysis
Through a large population-based cohort based on SEER database, we investigated whether the use of PORT will improve the prognosis of patients examined rare LNs metastasis

Summary

Introduction

Postoperative radiation (PORT) is an option for non-small cell lung cancer (NSCLC) patients with resectable stage IIIA pathological N2 status (pN2). In non-small cell lung cancer (NSCLC), the nodal status with metastases has been suggested to be of significance. NSCLC that is considered resectable, complete surgical resection is a favor choice of the management of localized non-small-cell cancer and the use of adjuvant platinum-based chemotherapy is considered the standard of care presently [1, 2]. Even after complete surgical resection and adjuvant chemotherapy, node-positive patients still have a 20% to 40% risk of localregional recurrence (LRR), and LRR correlates independently with worse OS for patients with NSCLC [2, 3]. Postoperative radiation therapy (PORT) is often recommended to improve local tumor control and survival in IIIA (N2) NSCLC patients with good performance status.

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