纵隔淋巴结包膜外软组织受侵对Ⅲ<sub>A</sub>—N<sub>2</sub>期NSCLC术后放疗效果的预测作用

doi:10.3760/cma.j.issn.1004-4221.2016.12.005

Abstract
Figure/Table
References()
Related Citation (15)
Read Tracking
Download Tracking

Download: PDF (838 KB) HTML (1 KB)
Export: BibTeX | EndNote (RIS) Supporting Info

Abstract

Objective To investigate the value of extracapsular extension (ECE) in prediction of the efficacy of postoperative radiotherapy (PORT) in the treatment of stage Ⅲ_A—N₂ non-small cell lung cancer (NSCLC). Methods From 2008 to 2009, 220 patients with stage Ⅲ_A—N₂ NSCLC who received surgical treatment were enrolled as subjects. All patients received postoperative chemotherapy and 43 out of them received PORT. Those patients were divided into ECE (+) group and ECE (-) group, which were further divided into subgroups according to whether PORT was applied or not. Progression-free survival (PFS) and overall survival (OS) rates were calculated using the Kaplan-Meier method and analyzed using log-rank test. Univariate and multivariate prognostic analyses were conducted using the log-rank test and the Cox model, respectively. Results The univariate analysis showed that the ECE (-) group had significantly improved PFS and OS rates than the ECE (+) group (P=0.000, 0.000). In the ECE (+) group, there were no significant differences in PFS or OS rate between the PORT subgroup and the non-PORT subgroup (P=0.584, 0.723). In the ECE (-) group, the PORT subgroup had a significantly improved PFS rate than the non-PORT subgroup (P=0.039), while there was no significant difference in OS rate between the two subgroups (P=0.125). The multivariate analysis indicated that ECE was an independent prognostic factor for PFS and OS rates in patients with stage Ⅲ_A—N₂ NSCLC (P=0.001, 0.020). Conclusions ECE is an independent prognostic factor for stage Ⅲ_A—N₂ NSCLC and promises to provide a basis for the use of PORT in the treatment of stage Ⅲ_A—N₂ NSCLC.

	Service

	E-mail this article
	Add to my bookshelf
	Add to citation manager
	E-mail Alert
	RSS
	Articles by authors
	Zhang Baozhong
	Yuan Zhiyong
	Zhao Lujun
	Pang Qingsong
	Wang Ping

Key words： Carcinoma,non-small cell lung/postoperative chemotherapy Carcinoma,non-small cell lung/postoperative radiotherapy Extracapsular extension Prognostic factor

Received: 11 August 2016

Corresponding Authors: Wang Ping,Email:ping_2016@16.com

Cite this article:

Zhang Baozhong,Yuan Zhiyong,Zhao Lujun et al. Extracapsular extension in prediction of the efficacy of postoperative radiotherapy in the treatment of stage Ⅲ_A—N₂ non-small cell lung cancer[J]. Chinese Journal of Radiation Oncology, 2016, 25(12): 1295-1300.

URL:

http://journal12.magtechjournal.com/Jweb_fszlx/EN/10.3760/cma.j.issn.1004-4221.2016.12.005 OR http://journal12.magtechjournal.com/Jweb_fszlx/EN/Y2016/V25/I12/1295

[1] Vansteenkiste JF,De Leyn PR,Deneffe GJ,et al. Clinical prognostic factors in surgically treated stage Ⅲ_A—N₂ non-small cell lung cancer:analysis of the literature[J].Lung Cancer,1998,19(1):3-11.
[2] Betticher DC,Hsu Schmitz SF,Ttsch M,et al. Prognostic factors affecting longterm outcomes in patients with resected stage Ⅲ_A pN₂ non-small-cell lung cancer:5-year follow-up of a phase Ⅱ study[J].Br J Cancer,2006,94(8):1099-1106.
[3] Arriagada R,Bergman B,Dunant A,et al. Cisplatin-based adjuvant chemotherapy in patients with completely resected non-small-cell lung cancer[J].N Engl J Med,2004,350(4):351-310.
[4] Douillard JY,Rosell R,De Lena M,et al. Adjuvant vinorelbine plus cisplatin versus observation in patients with completely resected stage Ⅰ_B–Ⅲ_A nonsmall-cell lung cancer (adjuvant navelbine international trialist association[ANITA]):a randomised controlled trial[J].Lancet Oncol,2006,7(9):719-727.
[5] Winton T,Livingston R,Johnson D,et al. Vinorelbine plus cisplatin vs. observation in resected non-small-cell lung cancer[J].N Engl J Med,2005,352(25):2589-2597.
[6] No authors listed。Postoperative radiotherapy in non-smallcell lung cancer:systematic review and meta-analysis of individual patient data from nine randomised controlled[J].Lancet,1998,352(9124):257-263.
[7] 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.
[8] Douillard JY,Rosell R,De Lena M,et al. Impact of postoperative radiation therapy on survival in patients with complete resection and stage Ⅰ,Ⅱ,or Ⅲ_A non-small-cell lung cancer treated with adjuvant chemotherapy:the adjuvant navelbine international trialist association (ANITA) randomized trial[J].Int J Radiat Oncol Biol Phys,2008,72(3):695-701.10.1016/j.ijrobp.2008.01.044.
[9] Ravdin PM₁,Davis G.Prognosis of patients with resected non-small cell lung cancer:impact of clinical and pathologic variables[J].Lung Cancer,2006,52(2):207-212.
[10] Sawyer TE,Bonner JA,Gould PM,et al. The impact of surgical adjuvant thoracic radiation therapy for patients with nonsmall cell lung carcinoma with ipsilateral mediastinal lymph node involvement[J].Cancer,1997,80(8):1399-1408.
[11] Emami B,Kaiser L,Simpson J,et al. Postoperative radiation therapy in non-small cell lung cancer[J].Am J Clin Oncol,1997,20(5):441-448.
[12] The Lung Cancer Study Group. Effects of postoperative mediastinal radiation on completely resected stage Ⅱ and stage Ⅲ epidermoid cancer of the lung[J].N Engl J Med,1986,315(22):1377-1381.
[13] Feng QF,Wang M,Wang LJ,et al. A study of postoperative radiotherapy in patients with non-small-cell lung cancer:a randomized trial[J].Int J Radiat Oncol Biol Phys,2000,47(4):925-929.
[14] Mayer R, Smolle-Juettner FM, Szolar D,et al. Postoperative radiotherapy in radically resected non-small cell lung cancer[J].Chest,1997,112(4):954-959.
[15] Stephens RJ,Girling DJ,Bleehen NM,et al. The role of postoperative radiotherapy in non-small-cell lung cancer:a multicentre randomised trial in patients with pathologically staged T_1-2,N_1-2,M₀ disease[J].Br J Cancer,1996,74(4):632-639.
[16] Choi NC,Grillo HC,Gardiello M,et al. Basis for new strategies in postoperative radiotherapy of bronchogenic carcinoma[J].Int J Radiat Oncol Biol Phys,1980,6(1):31-35.
[17] Scotti V, Meattini I, Saieva C,et al. Post-operative radiotherapy in N₂ non-small cell lung cancer:a retrospective analysis of 175 patients[J].Radiother Oncol,2010,96(1):84-88.10.1016/j.radonc.2010.05.010.
[18] Dai H,Hui Z,Ji W,et al. Postoperative radiotherapy for resected pathological stage Ⅲ_A—N₂ non-small cell lung cancer:a retrospective study of 221 cases from a single institution[J].Oncologist,2011,16(5):641-650.10.1634/theoncologist.2010-0343.
[19] Billiet C,Decaluwé H,Peeters S,et al. Modern post-operative radiotherapy for stage Ⅲ non-small cell lung cancer may improve local control and survival:a meta-analysis[J].Radiother Oncol,2014,110(1):3-8.10.1016/j.radonc.2013.08.011.
[20] Mantovani C,Levra NG,Filippi AR,et al. Filippi,et al. Postoperative radiotherapy for patients with completely resected pathologic N₂ non-small-cell lung cancer:a retrospective analysis[J].Clin Lung Cancer,2013,14(2):194-199.10.1016/j.cllc.2012.05.007.
[21] Matsuguma H,Nakahara R,Ishikawa Y,et al. Postoperative radiotherapy for patients with completely resected pathological stage Ⅲ_A—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):573-577.10.1510/icvts.2007.174342.
[22] Urban D, Bar J, Solomon B,et al. Solomon,et al. Lymph node ratio may predict the benefit of postoperative radiotherapy in non-small-cell lung cancer[J].J Thorac Oncol,2013,8(7):940-946.10.1097/JTO.0b013e318292c53e.
[23] Jonnalagadda S,Arcinega J,Smith C,et al. Validation of the lymph node ratio as a prognostic factor in patients with N₁ nonsmall cell lung cancer[J].Cancer,2011,117(20):4724-4731.10.1002/cncr.26093.
[24] Matsuguma H,Oki I,Nakahara R,et al. Proposal of new nodal classifications for non-small-cell lung cancer based on the number and ratio of metastatic lymph nodes[J].Eur J Cardiothorac Surg,2012,41(1):19-24.10.1016/j.ejcts.2011.04.016.
[25] Nwogu CE,Groman A,Fahey D,et al. Number of lymph nodes and metastatic lymph node ratio are associated with survival in lung cancer[J].Ann Thorac Surg,2012,93(5):1614-1619;discussion 1619-1620.10.1016/j.athoracsur.2012.01.065.
[26] Wang CL,Li Y,Yue DS,et al. Value of the metastatic lymph node ratio for predicting the prognosis of non-small-cell lung cancer patients[J].World J Surg,2012,36(2):455-462.10.1007/s00268-011-1360-8.
[27] Moretti L, Yu DS, Chen H,et al. Prognostic factors for resected non-small cell lung cancer with pN₂ status:implications for use of postoperative radiotherapy[J].Oncologist,2009,14(11):1106-1110.10.1634/theoncologist.2009-0130.