non-PORT Group Research Articles

Postoperative Radiotherapy in Curatively Resected Esophageal Squamous Cell Carcinoma With Occult Recurrent Laryngeal Nerve Lymph Node Metastasis.

Surgery is the mainstream treatment for early-stage esophageal squamous cell carcinoma (ESCC) and occult recurrent laryngeal nerve lymph node metastasis (RLNM) is not uncommon among those with R0 resection. The clinical value of postoperative radiotherapy (PORT) in patients with RLNM only is still controversial. Consecutive patients with early-stage ESCC treated with R0 resection and pathologically confirmed RLNM only from June 2012 to July 2022 were retrospectively reviewed. PORT, covering the supraclavicular and superior mediastinum area (small T-field) at a dose of 50.4Gy for 28 fractions, was performed in some patients. Propensity score matching (PSM) was performed to balance the baseline characteristics between patients with or without PORT. Pattern of failure, disease-free survival (DFS), and overall survival (OS) were compared. Among the 189 patients identified, 69 (35.5%) received PORT and the other 120 (63.5%) did not. After PSM, 154 patients were included in the matched cohort, including 62 in the PORT group and 92 in the non-PORT group. With a median follow-up of 48 (95% CI: 40.3-55.7) months, 69 patients developed their initial disease recurrence in the whole population and PORT significantly decreased the frequency of local recurrence (61.2% vs 21.4%) among those with recurrent disease. Additionally, in the PSM matched cohort, PORT significantly prolonged patients' DFS (HR 0.393, P = 0.002) and OS (HR 0.462, P = 0.020). Moreover, PORT remained as the independent factor associated with improved DFS (HR 0.360, P = 0.001) and OS (HR 0.451, P = 0.021) after multivariate Cox analyses. In addition, tumor location and pathological TNM stage were found to be independent prognostic factors associated with survival outcomes. PORT is associated with improved DFS and OS in ESCC patients with R0 resection and RLNM only, which warrants future validation.

Efficacy of Postoperative Radiotherapy for Patients with New N2 Descriptors of Subclassification in Completely Resected Non-Small Cell Lung Cancer: A Real-World Study

Patients with N2 non-small cell lung cancer (NSCLC) were heterogeneous groups and required further stratification. The International Society for the Study of Lung Cancer (IASLC) added new descriptors of three sub-stages for stage N2 NSCLC: N2 at a single station without N1 involvement (N2a1), N2 at a single station with N1 involvement (N2a2), and N2 at multiple stations (N2b). This study aimed to investigate the efficacy of postoperative radiotherapy (PORT) for patients with these N2 descriptors. Patients with histologically confirmed NSCLC after complete resection and divided into PORT group and non-PORT group. The primary endpoint was DFS. The second endpoints were overall survival (OS) and locoregional recurrence-free survival (LRFS). Propensity-score matching (PSM) of baseline characteristics between the PORT and non-PORT groups was used for validation. Totally 1832 patients were enrolled, including 308 N2a1 patients, 682 N2a2 patients, and 842 N2b patients. The median follow-up time was 50.1 months. The survival outcomes of the PORT and non-PORT groups before PSM were shown in Table 1. For patients with N2a1, PORT could not improve the DFS (median DFS of the PORT group and the non-PORT group: not reached vs. 46.8 months, P = 0.41), OS (P = 0.85), or LRFS (P = 0.32), which were consistent with the multivariate analysis and data after the PSM. For patients with N2a2, PORT significantly improved the DFS (median DFS 29.7 vs. 22.2 months, P = 0.02), OS (P = 0.03), and LRFS (P = 0.01). The multivariate analysis and data after the PSM confirmed the benefits in DFS and LRFS, but no benefit was observed in OS (multivariate analysis: HR 0.79, P = 0.18; median OS after PSM: 103.7 vs. 63.1 months, P = 0.34). For patients with N2b, PORT could not improve the DFS (median DFS 20.6 vs. 21.2 months, P = 0.39) but significantly improved the OS (P<0.001) and LRFS (P<0.001). However, the multivariate analysis showed that PORT significantly improved DFS (HR 0.81, P = 0.03), consistent with the data after the PSM (median DFS 20.6 and 17.6 months, P = 0.04). PORT significantly improved the DFS and LRFS in patients with N2a2 and significantly improved the DFS, LRFS, and OS in patients with N2b. Patients with N2a1 could not benefit from PORT.

The Value of Postoperative Radiotherapy in Thymoma with Myasthenia Gravis

For patients with thymoma combined with myasthenia gravis (MG), surgery is the first-line treatment. However, there is still debate on the effects of radiotherapy among these patients. This study is aimed to investigate the efficacy and prognosis of postoperative radiotherapy (PORT) on thymoma patients with MG. This retrospective cohort study included 126 patients with MG and thymoma from 2011 to 2021. Demographic data and information that were collected included sex, age, histologic subtype, Masaoka-Koga staging, the primary tumor, lymph node, and metastasis (TNM) staging and therapy modalities. Changes in the Quantitative Myasthenia Gravis Score (QMGs) within 3 months after treatment were used to evaluate the short-term MG symptom improvement after PORT. Minimal manifestation status (MMS) was the main endpoint of assessing the long-term MG symptom improvement. Overall survival (OS) and disease-free survival (DFS) were the primary endpoints for PORT in prognosis. Effects of PORT on MG symptom: there was a significant difference in QMG scores between non-PORT and PORT groups (χ2 = 6.300, p = 0.012). The median time to achieve MMS of patients in the PORT group was significantly shorter when compared with the non-PORT group (2.0 years versus 4.4 years [p = 0.031]). Multivariate analysis demonstrated that radiotherapy was associated with a shorter time to achieve MMS (HR 1.971, 95% CI:1.102-3.525, p = 0.022). Effects of PORT on DFS and OS: the 10-year OS rate of the whole cohort was 90.5%. The OS rates of the PORT group and the non-PORT group were 94.4% and 85.1% respectively. The 5-year DFS rates in the whole cohort, PORT group, and non-PORT group were 89.7%, 95.8%%, and 81.5%, respectively. PORT was associated with improved DFS (HR 0.139, 95% CI: 0.037-0.533, p = 0.004). In the high-risk histologic subgroup (type B2, B3), PORT exhibited better survival than non-PORT in OS (p = 0.015) and DFS (p = 0.0053). PORT remained associated with improved DFS (HR 0.232, 95% CI: 0.069-0.782, p = 0.018) in Masaoka-Koga staging II, III, and IV disease. The efficacy of PORT in patients with thymoma and MG is positive. Patients in the higher histologic subtype and Masaoka-Koga staging may benefit more obviously.

The high-risk features and effect of postoperative radiotherapy on survival for patients with surgically treated stage IIIA-N2 non-small cell lung cancer

ObjectivesAlthough postoperative radiotherapy (PORT) could reduce the incidence of local recurrence in patients with IIIA-N2 non-small cell lung cancer (NSCLC), the role of PORT on survival in patients with surgically treated stage IIIA-N2 NSCLC remains controversial. Therefore, this study was designed to evaluate the effect of PORT on survival for patients with surgically treated stage IIIA-N2 NSCLC.Materials and methodsThis study population was chosen from the Surveillance, Epidemiology, and End Results database. The Cox proportional hazards regression analysis was used to determine significant contributors to overall survival (OS) and cancer special survival (CSS) outcomes. To balance baseline characteristics between the non-PORT group and PORT group, propensity score matching (PSM) with 1:1 propensity nearest-neighbor match by 0.001 matching tolerance was conducted by R software. Furthermore, a Kaplan–Meier curve was used to visualize the OS and CSS between the PORT group and non-PORT group survival probability.ResultsOf all evaluated cases, 4511 with IIIA-N2 NSCLC were eligible for inclusion, of which 1920 were enrolled into the PORT group. On univariate analysis and multivariate analysis, sex, age, year of diagnosis, race, histologic type, T stage, PORT, use of chemotherapy, and positive regional nodes were significantly associated with OS and CSS in IIIA-N2 NSCLC (P < 0.05). However, PORT was not significantly associated with OS (univariate HR = 0.92, 95%CI 0.85–0.99, P = 0.02; multivariate HR = 1.01, 95%CI 0.93–1.08, P = 0.91) and CSS (univariate HR = 0.92, 95%CI 0.85–1.01, P = 0.06; multivariate HR = 1.103 95%CI 0.94–1.12, P = 0.56) in IIIA-N2 NSCLC. Meanwhile, after PSM, neither OS nor CSS did differ significantly between the non-PORT group and PORT group (OS HR = 1.08, 95%CI 0.98–1.19, P = 0.12; CSS HR = 1.10, 95%CI 0.99–1.23, P = 0.07).ConclusionPORT did not contribute to a survival benefit in patients with surgically treated stage IIIA-N2 NSCLC.

The association of postoperative radiotherapy with survival in resected N2 non-small cell lung cancer.

The current staging system for completely resected pathologic N2 non-small cell lung cancer (NSCLC) treated with chemotherapy is not suitable for distinguishing those patients most likely to benefit from postoperative radiotherapy (PORT). This study aimed to construct a survival prediction model that will enable individualized prediction of the net survival benefit of PORT in patients with completely resected N2 NSCLC treated with chemotherapy. A total of 3,094 cases from between 2002 and 2014 were extracted from the Surveillance, Epidemiology, and End Results (SEER) database. Patient characteristics were included as covariates, and their association with overall survival (OS) with and without PORT was assessed. Data from 602 patients from China were included for external validation. Age, sex, the number of examined/positive lymph nodes, tumor size, the extent of surgery, and visceral pleural invasion (VPI) were significantly associated with OS (P<0.05). Two nomograms were developed based on clinical variables to estimate individuals' net survival difference attributable to PORT. The calibration curve showed excellent agreement between the OS predicted by the prediction model and that actually observed. In the training cohort, the C-index for OS was 0.619 [95% confidence interval (CI): 0.598-0.641] in the PORT group and 0.627 (95% CI: 0.605-0.648) in the non-PORT group. Results showed that PORT could improve OS [hazard ratio (HR): 0.861; P=0.044] for patients with a positive PORT net survival difference. Our practical survival prediction model can be used to make an individualized estimate of the net survival benefit of PORT for patients with completely resected N2 NSCLC who have been treated with chemotherapy.

Is postoperative radiotherapy (PORT) a viable option in high-risk early-stage cervical cancer after upfront or downstaged radical surgery? A comparative study.

Radical surgery for cervical cancer has inherent benefits, and as upfront or post neoadjuvant chemotherapy (NACT), is extendable to locally advanced cancer cervix (LACC), with postoperative radiotherapy (PORT) for high-risk factors. Objective of the study was to compare the effectiveness and survival between non-PORT and PORT in high-risk early stages. Radical hysterectomies conducted between January 2014 and December 2017 were evaluated and followed till December 2019. Clinical, surgical-pathologic characteristics, and oncological outcomes were compared between non-PORT and PORT groups. A similar comparison was made between alive and dead patients within each group. The impact of PORT was assessed. Of 178 radical surgeries, early-LACC constituted 70%. Most (37%) of the patients belonged to stage 1b2, while stage 2b formed 5%. Mean age of patients was 46.5 years; 69% were below 50 years of age. Abnormal bleeding (41%) was the predominant symptom, followed by postcoital (20%) and postmenopausal bleeding (12%). Upfront surgeries formed 70.2%, and the average waiting period was 1.93 months (range: 1-10 months). PORT patients were 97 (54.5%) in number and the remaining formed the non-PORT group. Mean follow-up was 34 months, with 118 (66%) alive patients. Significant adverse prognostic factors were tumors >4 cm (44.4% patients), positive margins (10%), lymphatic vascular space invasion (LVSI; 42%), malignant nodes (33%), multiple metastatic nodes averaging seven (range: 3-11), and delayed (>6 months) presentation, but not deep stromal invasion (77% patients) and positive parametrium (8.4% patients). PORT overcame the adverse effects of tumors >4 cm, multiple metastatic nodes, positive margins, and LVSI. Total recurrences (25%) were balanced for both groups, but recurrences within 2 years were significantly more for PORT. Two-year overall survival (78%) and recurrence-free survival (72%), median overall survival (21 months), and median recurrence-free interval (19 months) were significantly better for PORT, with the complication rates being similar. PORT had significantly better oncological outcomes compared to non-PORT. Multimodal management is worthwhile.

Validation of the Role of Postoperative Radiotherapy in Improving Disease-Free Survival of Patients with Stage III ypN2 Non-Small Cell Lung Cancer after Neoadjuvant Therapy Followed by Complete Resection – A Propensity-Score Matching Study

<h3>Purpose/Objective(s)</h3> Although the Lung ART study, a phase III trial, showed that postoperative radiotherapy (PORT) could not significantly improve the disease-free survival (DFS) of patients with pN2 non-small cell lung cancer (NSCLC) after complete resection. However, its subgroup analysis showed that PORT did significantly improve the DFS of those with ypN2 NSCLC after neoadjuvant therapy and surgery. Our study aimed to validate the effect of PORT on the survival of patients with ypN2 NSCLC. <h3>Materials/Methods</h3> Patients was filtrated from our center from 2004 to 2021. The inclusion criteria of patients were as follows: 1) diagnosed with NSCLC; 2) accepted neoadjuvant systematic treatments including chemotherapy, tyrosine kinase inhibitors (EGFR, ALK), or immune checkpoint inhibitors; 3) received complete resection (R0 resection); 4) with stage III ypN2 disease (AJCC 8^th). We excluded patients with multiple primary malignant tumors and those who died within four months after surgery. The primary endpoint was DFS. The second endpoints were overall survival (OS) and locoregional recurrence-free survival (LRFS). Propensity-score matching (PSM) was used to match the baseline characteristics between the PORT group and the non-PORT group. Kaplan-Meier method was used to estimate the endpoints. All data were analyzed using R 4.1.2. <h3>Results</h3> Totally 185 patients were included in the final analysis. There were 49 patients (26.5%) with PORT. After 1:1 PSM between the PORT group and the non-PORT group, 82 patients remained with 41 in each group. The baseline characteristics of majority in the matched cohort were as follows: male (75.6%), smoking history (79.3%), performances scores 0-1 (100%), adenocarcinoma (47.6%), grade 3-4 (58.5%), receiving neoadjuvant chemotherapy (91.5%), lobectomy (82.9%), ypT1-2 (78.9%), and ypN2b (51.2%). The median age of patients was 58. The median numbers of examined and positive lymph nodes were 20.5 and 6. The median follow-up time was 49.5 months. The median DFS of the PORT group and the non-PORT group were 25.5 months vs. 18.6 months, with the 5-year DFS rates of 43.4% vs. 24.8%, respectively (P=0.044). The median LRFS of the two groups were not reached vs. 56.8 months, with the 5-year LRFS rates of 89.1% vs. 39.8% (P<0.001). The median OS of the two groups were not reached vs. 67.7 months, with the 5-year OS rates of 76.7% vs. 34.8% (P=0.092). <h3>Conclusion</h3> For patients with stage III ypN2 NSCLC after neoadjuvant systematic therapy followed by complete resection, PORT can significantly improve the DFS and LRFS, but failed to improve OS. However, the results need to be clarified by prospective randomized clinical trials.

Outcomes of Postoperative Radiotherapy in Male Breast Cancer Patients: A Population-Based Analysis

<h3>Purpose/Objective(s)</h3> Male breast cancer is rare, the treatment recommendations are typically extrapolated from clinical trials enrolling female breast cancer patients. The utilization of postoperative radiotherapy (PORT) and its impact on outcomes in male breast cancer patients has not been determined. In our study, we aimed to evaluate the role of postoperative radiotherapy for male breast cancer patients with stage I-III. <h3>Materials/Methods</h3> Male breast cancer patients diagnosed with stage I-III from 2010 to 2016 were selected from the Surveillance, Epidemiology, and End Result (SEER) database. Two cohorts were then created based on the PORT use. The two groups were compared based on demographic (age, race, marital status), tumor (stage, grade, lymph node status, ER/PR/HER2 status) as well as treatment characteristics (surgery type, chemotherapy). The Chi-square test was used to assess differences between treatment groups. The 1:1 propensity score matched (PSM) method was adopted to balance baseline characteristics. Kaplan–Meier curves were used to evaluate the impacts of PORT on survival. The effect of PORT on overall survival (OS) was evaluated using the Kaplan-Meier method and log-rank tests. Univariate and multivariate Cox analyses were used to analyze the factors associated with survival. <h3>Results</h3> Among 2636 patients, 29.1% (766) underwent PORT while the non-postoperative radiotherapy (non-PORT) group contained 70.9% (1870). After PSM, a total of 1242 patients were enrolled in this analysis, including 621 patients in the PORT group and 621 patients in the non-PORT group. Kaplan-Meier and the multivariate survival analysis demonstrated that the PORT group presented with a better prognosis compared to the non-PORT group (after PSM, 5y-OS 75.8% vs.67.6%; p=0.046). On multivariate analysis, there was a significant association between grade III/IV tumors, advanced stage, positive lymph node status, receipt of mastectomy, and radiotherapy and breast cancer death (p<0.05). After controlling for grade, stage, lymph node status, patients who underwent lumpectomy and PORT gained a better survival (5y-OS lumpectomy+PORT vs. mastectomy+PORT vs. mastectomy+non-PORT vs. lumpectomy+Non-PORT: 84.6% vs.71.8% vs.75.8% vs.52.1%; p<0.001). <h3>Conclusion</h3> PORT is associated with a significant survival advantage in OS. Lumpectomy with PORT may become a better option in appropriately selected men with breast cancer.

A decision support framework for postoperative radiotherapy in patients with pathological N2 non-small cell lung cancer

IntroductionPostoperative radiotherapy (PORT) plays a highly controversial role in pathological N2 (pN2) non-small cell lung cancer (NSCLC) disease. Recent studies reveal that not all patients can benefit from PORT. Further research is needed to identify predictors of PORT. MethodsA total of 1044 pathologic stage T1-3N2M0 NSCLC patients were analyzed. Risk factors of distant metastasis were identified by the log-rank tests and the multivariable Cox models. We integrated risk factors of distant metastasis and our previously published loco-regional recurrence (LRR) related prognostic index into a decision support framework (DSF) to predict the outcomes of PORT. An independent cohort was used to validate the DSF. ResultsWe defined patients with more than two of three identified LRR-related features (heavy cigarette smoking history, clinical N2 status, and more than four positive lymph nodes) as a high LRR risk group. We found the high-intermediate-risk histological type (with micropapillary and/or solid components) was associated with a higher risk of distant metastasis (HR = 1.207, 95 % CI 1.062 to 1.371, P = 0.0038), but not LRR. We built the DSF by combining these two types of features. Patients were stratified into four groups by using the DSF. PORT significantly improved OS only in the subgroup without high-risk histological features (without micropapillary or solid components) and with a high risk for LRR (three-year OS: 66.7 % in the PORT group vs 50.2 % in the non-PORT group; P = 0.023). ConclusionsA particular pN2 subgroup with a high risk of LRR and without micropapillary or solid components could benefit from PORT.

Is postoperative radiotherapy an essential treatment for nonmetastatic lymphoepithelial carcinoma of the salivary gland?

BackgroundLymphoepithelial carcinoma of salivary gland (LECSG) is a rare malignant tumor. Whether postoperative radiotherapy (PORT) can improve locoregional control and which patients can benefit from PORT are unknown. This study aimed to evaluate the role of PORT and provide individualized suggestions for postoperative therapy in patients with LECSG. Patients and methodsWe retrospectively reviewed patients with nonmetastatic LECSG who underwent surgery with or without PORT. Recursive partitioning analysis (RPA) was performed to categorize the patients and predict progression-free survival (PFS). ResultsA total of 223 patients were included, 34 (15.2%) received surgery alone, whereas the remaining 189 (84.8%) underwent PORT in the initial treatment. Although patients in the PORT group were with advanced T stage and N stage, the PORT group had an advantage over the non-PORT group on 1-year, 5-year and 10-year PFS and locoregional control (LRC). PORT was an independent prognostic factor for PFS and LRC. Furthermore, compared with T stage and N stage, the size of the primary tumor and the number of positive lymph nodes were better prognostic predictors. The RPA model was generated according to the endpoint of PFS and categorized patients into 3 prognostic groups: low-risk (maximum diameter of primary lesion (≤3 cm) and number of positive lymph nodes (≤2)), intermediate-risk (maximum diameter of primary lesion (>3 cm) and number of positive lymph nodes (≤2)), and high-risk (number of positive lymph nodes (>2)), with corresponding 5-year PFS rates of 90.0%, 75.0%, and 51.0%, respectively. Significant improvement in PFS was observed in the PORT group among intermediate-risk (P = 0.000) and high-risk patients (P = 0.000). ConclusionsPORT was shown to be a positive prognostic factor for PFS and LRC of LECSG. PORT was an essential treatment especially for patients with >3 cm maximum diameter of primary lesion and/or >2 positive lymph nodes.

Effects of postoperative radiotherapy on cardiovascular-pulmonary disease mortality in patients with stage IIIA-N2 resected NSCLC: analysis of the SEER database

BackgroundThe role of postoperative radiotherapy (PORT) in cardiovascular-pulmonary disease mortality in patients with stage IIIA-N2 resected non-small cell lung cancer (NSCLC) remains uncertain. The purpose of this population-based analysis was to explore the effect of PORT on cardiovascular-pulmonary disease mortality in these patients.MethodsPatients aged ≥ 18 years with stage IIIA-N2 resected NSCLC were identified in the Surveillance, Epidemiology, and End Results (SEER) database from 2004 to 2015 and were grouped according to the use of PORT. Propensity score matching (PSM) was used to account for differences in baseline characteristics between the Non-PORT and PORT groups. The cumulative risk for cardiovascular-pulmonary disease death was estimated using the cumulative incidence curve. Competing risk regression was used to run univariate and multivariate analyses to evaluate risk factors.ResultsA total of 3981 patients were included in the study population. Among them, 1446 patients received PORT, and 2535 did not. A total of 1380 patients remained in each group after PSM, and the baseline characteristics were not significantly different between the two groups. The cumulative incidence of cardiovascular-pulmonary mortality was 10.93% in the Non-PORT group compared with 9.85% in the PORT group. There was no significant difference in the cumulative risk between the two groups (HR 1.07, 95% CI 0.77–1.48, p = 0.703). Multivariate analysis indicated that PORT had no significant impact on increased risk, with an HR of 1.18 (p = 0.377).ConclusionsNo significant differences between the PORT and Non-PORT groups were found in cardiovascular-pulmonary-specific modalities in this study. Further studies are required to validate these results. This study highlights the importance of long-term surveillance for NSCLC patients.

86P Post-operative radiotherapy (PORT) vs non-PORT in non-small cell lung cancer patients: A systematic review and meta-analysis

Background: Non-small cell lung cancer (NSCLC) is the leading cause of death globally. At a certain stage, there is a risk of recurrence so Post-operative Radiation (PORT) is needed. Based on available data, PORT is performed in patients with N2 after adjuvant chemotherapy or after surgery while taking neoadjuvant chemotherapy. However, several studies showed that the survival of patients treated with and without PORT was not significantly different. This systematic review aims to evaluate the survival rate of the PORT and Non-PORT group in NSCLC patients.

Postoperative radiotherapy for patients with completely resected pathological stage IIIA-N2 non-small cell lung cancer: a preferential benefit for squamous cell carcinoma.

BackgroundThe beneficial effect of postoperative radiotherapy (PORT) on completely resected pathological IIIA-N2 (pIIIA-N2) non-small cell lung cancer (NSCLC) has been a subject of interest with controversy. The aim of the study was to distinguish the clinical efficacy of PORT on lung adenocarcinoma (LADC) and lung squamous cell carcinoma (LSCC) among pIIIA-N2 NSCLC.Patients and methodsBetween October 2010 and September 2016, 288 consecutive patients with completely resected pIIIA-N2 NSCLC at Beijing Chest Hospital were retrospectively analyzed, which consisted of 194 cases of LADC and 85 cases of LSCC. There were 42 (21.6%) patients treated with PORT in LADC cases and 19 (22.3%) patients treated with PORT in LSCC cases. The 5-year overall survival (OS), loco-regional recurrence-free survival (LRFS), distant metastasis-free survival (DMFS) were calculated using the Kaplan-Meier method. The prognostic factors were determined using Cox’s regression model.ResultsAmong 194 cases of LADC, the 1-, 3-, and 5-year OS in the PORT group were 95.2%, 61.9% and 40.0%, respectively, while in the non-PORT group were 90.1%, 63.3% and 45.0% (p = 0.948). The use of postoperative chemotherapy (POCT) and smoking index ≥ 400 were both prognostic factors of 5-year rates of OS, LRFS and DMFS. On the other hand, among 85 cases of LSCC, the 1-, 3-, and 5-year OS in the PORT group were 94.7%, 63.2% and 63.2%, respectively, whereas in the non-PORT group were 86.4%, 48.5% and 37.1% (p = 0.026). In this group, only the use of PORT was a favorable prognostic factor for 5-year OS, LRFS and DMFS.ConclusionsDue to clinicopathological differences among completely resected pIIIA-N2 NSCLC, PORT may not be suitable to all patients. Our study distinguishes pIIIA-N2 LSCC from LADC by their positive responses to PORT.

Postoperative Radiotherapy (PORT) Improves the Survival of Patients With N2 Non-Small Cell Lung Cancer (NSCLC) with Regional Nodes Examined (RNE) ≤16 - A Real World Study Using Surveillance, Epidemiology, and End Results (SEER) Database

PORT is widely used in patients with N2 NSCLC, but which subgroup population can benefit from PORT is still controversial. Our study is to evaluate the relationship between the RNE and the effect of PORT on survival of patients with N2 NSCLC from SEER database. Data from the SEER database were filtrated by the inclusion criteria of patients with NSCLC diagnosed at 2010-2016, with N2 disease (AJCC 7th) and treated with lobectomy or pneumonectomy. We excluded patients with unclear basic information (such as sex, histology or cause of death), multiple primary malignant tumors and M1 disease. All data were analyzed using the R version 3.6.2 software. And propensity-score matched (PSM) analysis was used to match the baseline characteristics between PORT group and non-PORT group. Kaplan-Meier method was used to estimate overall survival (OS) and cancer specific survival (CSS). Univariable and multivariable Cox proportional hazards models were adopted to estimate hazard ratios (HR) of predictors of survival. The HR of PORT for patients with different RNE was calculated to determine the best cut-off value of RNE. 2904 patients were included. The baseline characteristics were as follows: age≤70 (62.9%), white (80.5%), female (51.2%), grade 1-2 (53.0%), adenocarcinoma (67.1%), T2 (51.1%), lobectomy (89.9%), chemotherapy (74.9%), median number of positive regional nodes (3), median number of RNE (12). There were 1188 patients (40.9%) with PORT. RNE≤16 was chosen as the cut-off value and divided the patients into two cohorts. PSM was then conducted between the PORT group and the non-PORT group of each cohort. In RNE≤16 cohort (1398 patients), the median OS of the PORT and non-PORT groups were 48 months vs 40 months and 5-year OS rates were 42.93% vs 39.09%, respectively (P = 0.013). The median CSS were 59 months vs 44 months and 5-year CSS rates were 48.82% vs 43.15%, respectively (P = 0.008). Univariable analysis showed that PORT significantly improved OS (HR = 0.815, P = 0.013) and CSS (HR = 0.794, P = 0.008). Multivariable analysis confirmed that PORT was the significant predictor of OS (HR = 0.816, P = 0.014) and CSS (HR = 0.799, P = 0.011). In RNE>16 cohort (550 patients), The median OS of the PORT and non-PORT groups was 44 months vs 64 months and 5-year OS rates were 42.75% vs 50.69%, respectively (P = 0.210). The median CSS of the two groups were 47 months and not reached, the 5-year CSS rates were 46.17% vs 54.10%, respectively (P = 0.207). Neither univariable nor multivariable analysis showed that PORT was an individual predictive factor. For N2 NSCLC patients with RNE≤16, PORT can significantly improve the OS and CSS. However, for those with RNE>16, PORT may not improve survival, but even have the tendency of damage. These results need to be clarified by prospective randomized clinical trials.

Feasibility and Safely of Oral Rehydration Therapy before Upper Gastrointestinal Endoscopic Submucosal Dissection.

Methods We used alginade water (125 mL, Nestle Co., Kobe, Japan) for PORT. Alginade water is a flavored sports drink, which is palatable and promotes wound healing due to a high concentration of alginate. We conducted a single-center single-arm prospective feasibility study of PORT in 244 patients who underwent upper gastrointestinal ESD. The group wherein PORT was administered up to two hours before ESD (n = 120) was compared with the historical control group (non-PORT group, n = 120). We investigated the total fluid intake, hematocrit change, complications due to PORT, complications during ESD, ESD procedure time, and length of hospital stay in each group. Results The average fluid intake in the PORT group was 462.6 mL. No complications were observed due to PORT and ESD, and significant differences in the ESD procedure time or hospital stay was not noted. Conclusion PORT up to two hours before upper gastrointestinal ESD is feasible.

Association of postoperative radiotherapy with survival in patients with completely resected pathologic N2 non-small cell lung cancer treated with chemotherapy.

e21008 Background: The current staging system for completely resected pathological N2 non-small-cell lung cancer (NSCLC) treated with chemotherapy is not suitable for predicting those patients most likely to benefit or not from post-operative radiotherapy (PORT). This study aimed to construct a survival prediction model that will enable individualized predictions of the net survival of PORT. Methods: A total of 3094 cases between 2002 and 2014 were extracted from the Surveillance, Epidemiology, and End Results databases. Patient characteristics were included as covariates, and their association for overall survival (OS) with and witout PORT was assessed. Externally validate data of 602 patients were included from China. Results: A total of 3696 patients were included for analysis. Age, gender, examined lymph node, positive lymph node, tumor size, extent of surgery, and visceral pleural invasion were significantly associated with OS, with P &lt; .05. The calibration curve for OS showed great agreement between prediction by survival prediction model and actual observation.In the training cohort, the C-index for OS was 0.619 (95% CI, 0.598-0.641) in the PORT group and 0.627 (95% CI, 0.605-0.648) in the non-PORT group. In the externally validation cohort, the C-index for OS was 0.599 (95% CI, 0.485- 0.713) in the PORT group and 0.595 (95% CI, 0.544-0.646) in non-PORT group. The two survival prediction models were developed based on clinical variables to estimate an individual's net survival gain or not attributable to PORT. We found that PORT could improve OS (HR, 0.861; P = 0.044) for patients with a positive PORT net survival benefit. Conclusions: We established a practical survival prediction model that can be used to make individualized predictions about the expected survival of PORT or without PORT in patients with completely resected pathological N2 NSCLC, treated with chemotherapy.

Radiotherapy for patients with completely resected pathologic IIIA(N2) non-small-cell lung cancer: a retrospective analysis.

IntroductionAdjuvant radiotherapy in non–small-cell lung cancer (NSCLC) remains controversial,Whether the mutation status of epidermal growth factor receptor (EGFR) will affect the recurrence and survival of patients with resected NSCLC is rarely reported. Our purpose is to study the effect of postoperative radiotherapy on patients with stage IIIA(N2) NSCLC with EGFR mutation.MethodsTotal of of 115 patients diagnosed with stage IIIA(N2) resected NSCLC were analyzed retrospectively. Their EGFR mutations were detected by real-time quantitative PCR and DNA sequencing technology together.ResultsAt a median follow-up of 34.2 months for the postoperative adjuvant radiotherapy (PORT) group and 31.0 months for the non-PORT group, PORT group significantly improved progression free survival (PFS) and overall survival (OS). The median PFS and OS in the EGFR mutant group were not significantly longer than those in the EGFR wild-type group. The number of chemotherapy cycles, postoperative radiotherapy and the number of metastatic lymph nodes were independent factors influencing long-term survival.ConclusionOur retrospective analysis showed that PORT can improve survival of patients with stage IIIA(N2) NSCLC. EGFR-mutant group with stage IIIA(N2) NSCLC has a tendency of a higher survival than the wild-type EGFR group, but there was no significant difference for both groups. The EGFR mutation status was not associated with PFS or OS of stage IIIA(N2) NSCLC.

Patients with ypN2 Non-Small Cell Lung Cancer after Neoadjuvant Chemotherapy Followed By Surgery Can Benefit from Postoperative Radiotherapy- a Retrospective Study of Surveillance, Epidemiology, and End Results Database

Neoadjuvant chemotherapy followed by surgery (NCS) is a common therapy pattern of resectable non-small cell lung cancer (NSCLC). However, for patients with ypN2 disease after aforementioned treatment, there is no evidence that postoperative radiotherapy (PORT) should be adopted or not. Our study is to evaluate the effect of PORT on survival of patients with ypN2 NSCLC after NCS from Surveillance, Epidemiology, and End Results (SEER) database. We filtrated data from SEER database by the inclusion criteria of patients with NSCLC diagnosed at 2004-2015, treated with NCS, and with ypN2 disease (2004-2009 AJCC 6th, 2010-2015 AJCC 7th). We excluded patients with unclear basic information (such as sex, histology or cause of death), multiple primary malignant tumor and M1 disease. All data were analyzed using statistical analysis software and propensity-score matched analysis was used to match the base-line characteristics between PORT group and non-PORT group. Kaplan-Meier method was used to estimate overall survival (OS) and cancer specific survival (CSS). Univariable and multivariable Cox proportional hazards models were adopted to estimate hazard ratios (HR) of predictors of survival. From 331 patients receiving NCS, 215 meeting the criteria were included in the final analysis. There were 112 patients (52.1%) with PORT. The baseline characteristics of majority were as follows: age≤65 (55.3%), white (82.3%), female (54.4%), grade 3-4 (63.3%), adenocarcinoma (60.0%), tumor size of 3-5 cm (38.6%), lobectomy (80.0%) and positive lymph nodes≥4 (51.2%). There were 200 patients remained after the prosperity score matching between the PORT group and the non-PORT group, with 100 cases in each. The median OS of the two groups were 36 months vs 26 months and 5-year OS rates were 36.2% vs 20.3%, respectively (P=0.011). The median CSS were 36 months versus 27 months and 5-year CSS were 38.5% vs 21.1%, respectively (P=0.010). Univariable analysis showed that only PORT significantly improved OS (HR=0.648, P=0.013) and CSS (HR=0.639, P=0.012). Multivariable analysis confirmed that PORT was the only significant predictor of OS (HR=0.615, P=0.011) and CSS (HR=0.614, P=0.013). For patients with ypN2 NSCLC after NCS, PORT can significantly improve the OS and CSS . However, the result needs to be clarified by prospective randomized clinical trials.

Postoperative Radiotherapy (PORT) Improves Survivals of Resected pN2 Non-Small Cell Lung Cancer (NSCLC): A Propensity Score-Matched (PSM) Analysis

To evaluate the effect of PORT on survivals as well as tumor control in patients with pN2 NSCLC after complete resection. From Jan. 2003 to Dec. 2015, patients with resected pN2 NSCLC at our institution were retrospectively studied. PSM analysis was conducted to generate comparable study arms. The effect of PORT on survivals (OS, DFS, LRFS, and DMFS) were evaluated using the Kaplan–Meier method and log-rank tests. Cox’s proportional hazards model was used for multivariate analysis. A statistically significant difference was set as p＜0.05. Totally 1434 patients were enrolled, including 341 (23.8%) in the PORT group and 1093 (76.2%) in the non-PORT group. The median follow-up time was 41.8 months. Patients treated with PORT had significantly longer OS (p＜0.001) and DFS (p=0.001) when compared with the control, as well as LRFS (p＜0.001) and DMFS (p=0.015). Multivariate analyses showed that PORT was an independent prognostic factor associating with better OS (HR=0.756, p=0.012). Moreover, we analyzed the effect of PORT on survivals for pⅢA–N2 NSCLC patients who received adjuvant chemotherapy using PSM to balance several covariates. After adjustment, PORT also significantly improved the survivals. The 3- and 5-year OS rates were 72.9% and 56.1%, respectively in the PORT group and were 62.6% and 41.7%, respectively in the control group (p=0.01). The 3- and 5-year DFS rates were 38.9% and 29.5%, respectively in the PORT group and were 21.6% and 13.2%, respectively in the control group (p＜0.001). The 3- and 5-year LRFS rates were 59.0% and 43.8% versus 38.3% and 20.5% in the PORT versus control group, respectively(p＜0.001). The 3- and 5-year DMFS rates were 44.5% and 33.2% versus 30.6% and 15.0% in the PORT versus control group, respectively (p＜0.0001). For NSCLC patients with resected pN2 or pⅢA-N2 receiving adjuvant chemotherapy, PORT can significantly improve the rates of OS, DFS, LRFS and DMFS. A prospective randomized multicenter clinical trial led by our institution is ongoing now.

Postoperative Radiation Therapy Has No Effect in Improving the Survival of Patients Aged ≤55 Years with Completely Resected Pathological Stage IIIA-N2 Non-Small-Cell Lung Cancer

For patients with completely resected pathological stage IIIA–N2 non-small cell lung cancer (NSCLC), studies has shown that postoperative radiotherapy (PORT) does not improve survivals of elderly patients (＞65 years). However, the role of PORT for younger patients is not well defined. This study is to evaluate the effect of PORT on survivals as well as tumor control in patients ≤65 years. Between Jan. 2003 and Dec. 2015, patients, ≤65 years, with pIIIA–N2 NSCLC after complete resection in our single institution were retrospectively analyzed. The effect of PORT on overall survival (OS), disease free survival (DFS), loco-regional recurrence free survival (LRFS), and distant metastasis free survival (DMFS) was evaluated with Kaplan-Meier method and log-rank test. Multivariable Cox regression analysis was used to identify independent risk factors for death. Pearson chi-square test was used to compare the constituent ratios between groups. Propensity score-matched (PSM) analysis was conducted to generate comparable study arms. Statistically significant difference was set as p<0.05. Overall, 940 consecutive patients ≤65 years were enrolled. The median follow-up was 31.1 months. The median age was 55 years (range, 25–65 years). The characteristics were comparable between the PORT group and non-PORT group, except that more patients with ≥4 positive lymph nodes and receiving chemotherapy in the PORT group. The 3- and 5-year OS rates were 75.3% and 63.1%, respectively, in the PORT group, which were statistically significantly higher than 68.2% and 53.3% in the non-PORT group (p=0.023). The differences between the two groups were also significant in the DFS and LRFS rates (p=0.006 and 0.000, respectively), but not in the DMFS rate (p=0.062). After adjustment by PSM, PORT still resulted in significantly better survivals of OS, DFS, LRFS and DMFS than non-PORT group (p=0.009, 0.000, 0.000 and 0.000, respectively). Then patients were divided into younger group (≤50 years, n=269), middle-age group (51-55 years, n=218) and older group (56-65 years, n=453). PORT significantly improved the OS in the older group, The 3- and 5-year OS rates were 75.8% and 59.1% in the PORT group vs. 61.5% and 45.7% in the non-PORT group, respectively (p=0.019). The OS was not improved by PORT in the younger or middle-age groups (p=0.859 and 0.524, respectively). When the patients in the younger and middle-age groups was merged together (≤55 years), the OS was not improved by PORT neither (p=0.626). In multivariable analysis, PORT was not significantly associated with better prognosis of patients ≤55 years old (p=0.902). For patients with completely resected pIIIA–N2 NSCLC, PORT can significantly improve the OS of patients aged 56-65 years, but not in patients aged ≤55 years. The result needs to be validated in the future study.