Abstract
BackgroundThe 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.Methods17,654 (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.ResultsWe 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.ConclusionsIn 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.
Highlights
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
Baseline cohort characteristics Based on the inclusion criteria, this study cohort was formed by 17,654 IIIA/N2 NSCLC patients, of which 8786 males and 8868 females
Patients that underwent surgery only (40.69%) constitute the vast majority of patients included in the study, while those treated with radiotherapy both before and after surgery (0.57%) were the least representative, especially in elderly patients
Summary
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. In patients diagnosed with lung cancer, 15% are stage IIIA NSCLC [2,3,4], while stage IIIA pathologic N2 (IIIA/N2) account for. 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]. The optimal treatment for IIIA/N2 NSCLC is still controversial because stage IIIA/N2 NSCLC patients form a very broad and diverse population [10, 11]
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