[an error occurred while processing this directive]|[an error occurred while processing this directive]
术后放疗在Ⅲ(pN2)期EGFR基因野生型肺腺癌辅助化疗患者中价值
贺春语, 马聪, 陈慧静, 聂新, 李鹏, 吴小源, 张成娟, 王总飞, 刘宝兴, 刘如, 葛红
河南省肿瘤医院 郑州大学附属肿瘤医院放疗科 450008
Efficacy of postoperative radiotherapy and prognosis in patients with completely resected stage Ⅲ(pN2) lung adenocarcinoma with EGFR wild-type receiving adjuvant chemotherapy
He Chunyu, Ma Cong, Chen Huijing, Nie Xin, Li Peng, Wu Xiaoyuan, Zhang Chengjuan, Wang Zongfei, Liu Baoxing, Liu Ru, Ge Hong
Department of Radiation Oncology, Henan Cancer Hospital, Affiliated Cancer Hospital of Zhengzhou University, Zhengzhou 450008, China
Abstract：Objective To evaluate the value and identify the prognosic factors of postoperative radiotherapy (PORT) in completely resected stage Ⅲ(pN2) lung adenocarcinoma patients with epidermal growth factor receptor (EGFR) wild-type who received adjuvant chemotherapy. Methods Clinical data of 172 patients with stage Ⅲ(pN2) EGFR wild-type lung adenocarcinoma who underwent radical resection and adjuvant chemotherapy from 2009 to 2016 were retrospectively analyzed. All patients received platinum-based adjuvant chemotherapy combining two drugs for>4 cycles, and divided into the PORT group and the non-PORT group. The survival rate was calculated by Kaplan-Meier method and log-rank test, and multivariate prognostic analysis was performed by Cox’s regression model. Results Among 172 patients, the median overall survival (OS), 3-year and 5-year OS rates were 40 months, 55.9% and 28.3%, respectively. The median disease-free survival (DFS), 3-year and 5-year DFS rates were 17 months, 24.5% and 13.0%, respectively. DFS was significantly improved in the PORT group (29 months vs. 13 months, P=0.001), whereas OS did not significantly differ between two groups (51 months vs. 38 months,P=0.151). In subgroup analysis,DFS of patients with multistation N2 or the number of N2 metastases of≥3 or skip N2 in the PORT group was significantly longer (P<0.05), whereas PORT exerted no significant effect on OS (P>0.05). Conclusions For patients with completely resected stage Ⅲ(N2) EGFR wild-type lung adenocarcinoma receiving adjuvant chemotherapy, PORT might increase DFS and have a trend toward longer OS. However, these findings remain to be validated by large sample size investigations.
He Chunyu,Ma Cong,Chen Huijing et al. Efficacy of postoperative radiotherapy and prognosis in patients with completely resected stage Ⅲ(pN2) lung adenocarcinoma with EGFR wild-type receiving adjuvant chemotherapy[J]. Chinese Journal of Radiation Oncology, 2021, 30(5): 451-456.
[1] 中国抗癌协会肺癌专业委员会,中华医学会肿瘤学分会肺癌学组. Ⅲ期非小细胞肺癌多学科诊疗专家共识(2019版)[J]. 中华肿瘤杂志, 2019, 41(12):881-890. DOI:10.3760/cma.j.issn.0253-3766.2018.001. Chinese Anti-Cancer Association, Committee of Lung Cancer Society, Lung Cancer Group of Oncology Branch, Chinese Medical Association. Chinese expert consensus on the multidisciplinary clinical diagnosis and treatment of stage Ⅲ non-small cell lung cancer (2019)[J]. Chin J Oncol, 2019,1(12):881-890. DOI:10.3760/cma.j.issn.0253-3766.2018.001. [2] Lally BE, Zelterman D, Colasanto JM, et al. Postoperative radiotherapy for stage Ⅱ or Ⅲ non-small-cell lung cancer using the surveillance, epidemiology, and end results database[J]. J Clin Oncol, 2006, 24(19):2998-3006. DOI:10.1200/JCO.2005.04.6110. [3] 张瑞,乔学英. 非小细胞肺癌术后放疗的研究现状[J]. 中华放射肿瘤学杂志,2016, 25(1):81-84. DOI:10.3760/cma.j.issn.1004-4221.2016.01.020. Zhang R, Qiao XY. Research status of postoperative radiotherapy for non-small cell lung cancer[J]. Chin J Radiat Oncol, 2016, 25(1):81-84. DOI:10.3760/cma.j.issn.1004-4221.2016.01.020. [4] Travis WD, Brambilla E, Nicholson AG, et al. The 2015 World Health Organization Classification of lung tumors impact of genetic, clinical and radiologic advances since the 2004 classification[J]. J Thorac Oncol, 2015, 10(9):1243-1260. DOI:10.1097/JTO.0000000000000630. [5] Lin YK, Hsu HL, Lin WC, et al. Efficacy of postoperative radiotherapy in patients with pathological stage N2 epidermal growth factor receptor wild type adenocarcinoma and squamous cell carcinoma lung cancer[J]. Oncotarget, 2017, 8(21):35280-35288. DOI:10.18632/oncotarget.13257. [6] 支修益,石远凯,于金明. 中国原发性肺癌诊疗规范(2015年版)[J]. 中华肿瘤杂志,2015, 37(1):67-78. DOI:10.3760/cma.j.issn.0253-3766.2015.01.014. Zhi XY, Shi YK, Yu JM. Standards for the diagnosis and treatment of primary lung cancer in China (2015 version)[J]. Chin J Oncol, 2015, 37(1):67-78. DOI:10.3760/cma.j.issn.0253-3766.2015.01.014. [7] Bezjak A, Temin S, Franklin G, et al. Definitive and adjuvant radiotherapy in locally advanced non-small-cell lung cancer:American society of clinical oncology clinical practice guideline endorsement of the American society for radiation oncology evidence-based clinical practice guideline[J]. J Clin Oncol, 2015, 33:2100-2105. DOI:10.1200/JCO.2014.59.2360. [8] PORT Meta-analysis Trialists Group. Postoperative radiotherapy in non-small-cell lung cancer:systematic review and meta-analysis of individual patient data from nine randomised controlled trials[J]. Lancet, 1998, 352:257-263. DOI:10.1016/S0140-6736(98)06341-7. [9] Corso CD, Rutter CE, Wilson LD, et al. Re-evaluation of the role of postoperative radiotherapy and the impact of radiation dose for non-small-cell lung cancer using the national cancer database[J]. J Thorac Oncol, 2015, 10(1):148-155. DOI:10.1097/JTO.0000000000000406. [10] 刘禹汐,张大昕. 非小细胞肺癌EGFR基因与放疗敏感性的研究进展[J]. 国际免疫学杂志,2019, 42(3):329-332. DOI:10.3760/cma.j.issn.1673-4394.2019.03.020. Liu YX, Zhang DX. The research progress of epidermal growth factor receptor gene and radiosensitivity in non-small cell lung cancer[J]. Int J Immunol, 2019, 42(3):329-332. DOI:10.3760/cma.j.issn.1673-4394.2019.03.020. [11] Zhong WZ, Wang Q, Mao WM, et al. Gefitinib versus vinorelbine plus cisplatin as adjuvant treatment for stage Ⅱ-ⅢA(N1-N2), EGFR-mutant NSCLC (ADJUVANT/CTONG1104):a randomised, open-label, phase 3 study[J]. Lancet Oncol, 2018, 19(1):139-148. DOI:10.1016/S1470-2045(17)30729-5. [12] Yue DS, Xu SD, Wang Q, et al. Erlotinib versus Vinorelbine plus Cisplatin as adjuvant therapy in Chinese patients with stage ⅢA EGFR mutation-positive non-small-cell lung cancer (EVAN):a randomised, open-label, phase 2 trial[J]. Lancet Respir Med, 2018, 6(11):863-873. DOI:10.1016/S2213-2600(18)30277-7. [13] Lin YK, Hsu HL, Lin WC, et al. Efficacy of postoperative radiotherapy in patients with pathological stage N2 epidermal growth factor receptor wild type adenocarcinoma and squamous cell carcinoma lung cancer[J]. Oncotarget, 2017, 8(21):35280-35288. DOI:10.18632/oncotarget.13257. [14] Matsuguma H, Nakahara R, Ishikawa Y, et al. Postoperative radiotherapy for patients with completely resected pathological stage ⅢA-N2 non-small cell lung cancer:focusing on an effect of the number of mediastinal lymph node stations involved[J]. Interact CardioVasc Thorac Surg, 2008, 7(4):573-577. DOI:10.1510/icvts.2007.174342. [15] Gao F, Li N, Xu Y, et al. Effects of postoperative radiotherapy on survival of patients with stage ⅢA resected non-small cell lung cancer:analysis of the SEER database[J]. J Natl Compr Canc Netw, 2020, 18(6):718-727. DOI:10.6004/jnccn.2020.7537. [16] Li H, Hu H, Wang R, et al. Lung adenocarcinoma:are skip N2 metastases different from non-skip?[J]. J Thorac Cardiovasc Surg, 2015, 150(4):790-795. DOI:10.1016/j.jtcvs.2015.03.067. [17] Yazgan S, Ucvet A, Gursoy S, et al. Single-station skip-N2 disease:good prognosis in resected non-small-cell lung cancer (long-term results in skip-N2 disease)[J]. Interact Cardiovasc Thorac Surg, 2019, 28(2):247-252. DOI:10.1093/icvts/ivy244.
2021, Vol. 30 
