【答疑】IIIA期非小细胞肺癌患者，术后要不要放疗？学术资讯

来源：中华医学会胸心分会

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术后放疗对IIIA期非小细胞肺癌患者生存率的影响：基于SEER数据库的分析
— 结论—

在转移淋巴结6个及以上的IIIA-N2非小细胞肺癌患者中，术后放疗（PORT）可显著提高患者总生存率，并降低肺癌相关死亡率。对于N0和N1患者不推荐使用PORT。
Our results revealed that PORT significantly improved overall survival and decreased lung cancer-related mortality in patients with stage IIIA, N2 disease with ≥6 positive lymph node metastases. PORT was not recommended for patients with N0 and N1 disease.

— 背景—
术后放疗（PORT）在IIIA期非小细胞肺癌（NSCLC）患者中的作用仍存在争议。本研究旨在探讨PORT对这些患者生存的影响。
The role of postoperative radiotherapy (PORT) in patients with resected stage IIIA non-small cell lung cancer (NSCLC) remains controversial. The purpose of this study was to explore the effect of PORT on survival of these patients.
— 方法—
采用SEER数据库对2010-2015年年龄≥18岁的IIIA期NSCLC患者进行分析。
采用Cox回归分析确定IIIA期NSCLC患者的独立预后因素。对不同N分期患者进行亚组分析。
采用Kaplan-Meier分析和竞争性风险分析比较不同组的总生存率和肺癌相关死亡。

Patients aged ≥18 years with stage IIIA NSCLC were identified in the SEER database from 2010 through 2015. Cox regression analysis was used to identify independant prognostic factors in patients with stage IIIA NSCLC. Subgroup analysis of patients stratified by N stage was also performed. Overall survival and lung cancer-related death were compared among the different groups by using Kaplan-Meier analysis and competitive risk analysis.

— 结果—
共有5168例患者（其中1711例接受了PORT治疗）。
在多变量分析中，PORT是N1期患者的独立预后危险因素（危险比[HR]，1.416，95%CI，1.144-1.753；P=.001）。
对于IIIA-N2期淋巴结阳性≥6个的患者，PORT是一个有利的预后因素（HR，0.742；95%CI，0.587-0.938；P=.012）。
IIIA-N2期淋巴结阳性≥6个的患者术后化疗联合放疗的中位生存时间明显长于单纯化疗的患者（分别为32个月和25个月，P=0.009）。
竞争风险模型显示，在用PORT治疗的N1疾病患者中，3年和5年肺癌相关死亡率分别增加了8.99%和16.92%，而对N2病和≥6个阳性淋巴结行PORT治疗的患者，3年死亡率下降4.67%，5年死亡率下降10.08%。
A total of 5,168 patients (1,711 of whom received PORT) were included in the study. In multivariable analysis, PORT was an independent prognostic risk factor for patients with N1 stage (hazard ratio [HR], 1.416, 95% CI, 1.144-1.753; P=.001). PORT was a favorable prognostic factor for patients with stage IIIA, N2 disease with ≥6 positive lymph nodes (HR, 0.742; 95% CI, 0.587-0.938; P=.012). Median survival time of patients with stage IIIA, N2 disease with ≥6 positive lymph nodes who received postoperative chemotherapy combined with PORT was significantly longer compared with those who received postoperative chemotherapy alone (32 vs 25 months, respectively; P=.009). The competitive risk model revealed that 3- and 5-year lung cancer-related mortality rates increased by 8.99% and 16.92%, respectively, in patients with N1 disease who were treated with PORT, whereas the 3-year mortality rate decreased by 4.67% and the 5-year mortality rate by 10.08% in patients with N2 disease and ≥6 positive lymph nodes who were treated using PORT.
来源：知识城邦作者：多喝热水

来源：CSTCVS1985 中华医学会胸心分会

原文链接：https://mp.weixin.qq.com/s?__biz=MzA3NDQwNzQ3OA==&mid=2649076288&idx=3&sn=42bb905f35b1946677bef8b98fbb2a04&chksm=87115919b066d00f02f52c65ca95cd9076f0132a92f5b0aa7ce6c9d4c73b9417482eb99649ba#rd

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