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Zeng Y, Pu XX, He FJ, Hu CH, Zhu H, Huang Y, Peng YR, Zou JA, Liu JQ, Shi SH, Liu YF, Ma F, Deng C, Qiu ZH, Li YL, Zhang YZ, Huang K, Liu XL, Wu F. The efficacy of postoperative radiotherapy in resected pⅢA-N2 EGFR mutant and wild-type lung adenocarcinoma. iScience 2024; 27:110219. [PMID: 39021795 PMCID: PMC11253153 DOI: 10.1016/j.isci.2024.110219] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2023] [Revised: 04/12/2024] [Accepted: 06/05/2024] [Indexed: 07/20/2024] Open
Abstract
The resected pⅢA-N2 non-small-cell lung cancer (NSCLC) patients who could benefit from postoperative radiotherapy (PORT) are not well-defined. The study explored the role of PORT on EGFR mutant and wild-type NSCLC patients. We retrospectively searched for resected pIIIA-N2 lung adenocarcinoma patients who underwent EGFR mutation testing. 80 patients with EGFR wild-type and 85 patients with EGFR mutation were included. 62 patients received PORT. In overall population, the median disease-free survival (DFS) was improved in PORT arm compared to non-PORT arm (22.9 vs. 16.1 months; p = 0.036), along with higher 2-year locoregional recurrence-free survival (LRFS) rate (88.3% vs. 69.3%; p = 0.004). In EGFR wild-type patients, PORT was associated with a longer median DFS (23.3 vs. 17.2 months; p = 0.044), and a higher 2-year LRFS rate (86.8% vs. 61.9%; p = 0.012). In EGFR mutant patients, PORT was not significantly correlated with improved survival outcomes. EGFR wild-type may a biomarker to identify the cohort that benefits from PORT.
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Affiliation(s)
- Yue Zeng
- Department of Oncology, The Second Xiangya Hospital, Central South University, Changsha, Hunan 410011, China
| | - Xing-Xiang Pu
- Department of Medical Oncology, Lung Cancer and Gastrointestinal Unit, Hunan Cancer Hospital/The Affiliated Cancer Hospital of Xiangya School of Medicine, Central South University, Changsha, Hunan 410013, China
| | - Feng-Jiao He
- Department of Oncology, Xiangya Hospital, Central South University, Changsha, Hunan 410008, China
- Hunan Academy of Traditional Chinese Medicine Affiliated Hospital, Changsha, Hunan 410006, China
| | - Chun-Hong Hu
- Department of Oncology, The Second Xiangya Hospital, Central South University, Changsha, Hunan 410011, China
- Hunan Cancer Mega-Data Intelligent Application and Engineering Research Centre, Changsha, Hunan 410011, China
| | - Hong Zhu
- Department of Oncology, Xiangya Hospital, Central South University, Changsha, Hunan 410008, China
| | - Yan Huang
- Department of Oncology, The Second Xiangya Hospital, Central South University, Changsha, Hunan 410011, China
| | - Yu-Rong Peng
- Department of Oncology, The Second Xiangya Hospital, Central South University, Changsha, Hunan 410011, China
| | - Ji-An Zou
- Department of Oncology, The Second Xiangya Hospital, Central South University, Changsha, Hunan 410011, China
| | - Jun-Qi Liu
- Department of Oncology, The Second Xiangya Hospital, Central South University, Changsha, Hunan 410011, China
| | - Sheng-Hao Shi
- Department of Oncology, The Second Xiangya Hospital, Central South University, Changsha, Hunan 410011, China
| | - Yue-Fei Liu
- Department of Oncology, The Second Xiangya Hospital, Central South University, Changsha, Hunan 410011, China
| | - Fang Ma
- Department of Oncology, The Second Xiangya Hospital, Central South University, Changsha, Hunan 410011, China
| | - Chao Deng
- Department of Oncology, The Second Xiangya Hospital, Central South University, Changsha, Hunan 410011, China
| | - Zhen-Hua Qiu
- Department of Oncology, The Second Xiangya Hospital, Central South University, Changsha, Hunan 410011, China
| | - Yan-Long Li
- Department of Oncology, The Second Xiangya Hospital, Central South University, Changsha, Hunan 410011, China
| | - Ying-Zhe Zhang
- Department of Oncology, The Second Xiangya Hospital, Central South University, Changsha, Hunan 410011, China
| | - Kun Huang
- Department of Oncology, The Second Xiangya Hospital, Central South University, Changsha, Hunan 410011, China
| | - Xian-Ling Liu
- Department of Oncology, The Second Xiangya Hospital, Central South University, Changsha, Hunan 410011, China
| | - Fang Wu
- Department of Oncology, The Second Xiangya Hospital, Central South University, Changsha, Hunan 410011, China
- Hunan Cancer Mega-Data Intelligent Application and Engineering Research Centre, Changsha, Hunan 410011, China
- Hunan Key Laboratory of Tumor Models and Individualized Medicine, The Second Xiangya Hospital, Central South University, Changsha, Hunan 410011, China
- Hunan Key Laboratory of Early Diagnosis and Precision Therapy in Lung Cancer, The Second Xiangya Hospital, Central South University, Changsha, Hunan 410011, China
- FuRong Laboratory, Changsha, Hunan 410078, China
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Tian C, Liu G, Xu Y, Xia G, Zhang T, Huang J, Jiang H, Ming Wang J, Li B. Postoperative radiotherapy for patients with completely resected pathological stage IIIA-N2 non-small cell lung cancer: a preferential benefit for squamous cell carcinoma. Radiol Oncol 2020; 55:66-76. [PMID: 33885242 PMCID: PMC7877270 DOI: 10.2478/raon-2020-0070] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2020] [Accepted: 10/06/2020] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND The 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 METHODS Between 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. RESULTS Among 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. CONCLUSIONS Due 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.
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Affiliation(s)
- Cuimeng Tian
- Department of Radiation Oncology, Beijing Tuberculosis and Thoracic Tumor Research Institute / Beijing Chest Hospital, Capital Medical University, Beijing, China
- Laboratory of Cancer ImmunoMetabolism, Center for Cancer Research, National Cancer Institute at Frederick, Frederick, USA
| | - Guimei Liu
- Department of Radiation Oncology, Beijing Tuberculosis and Thoracic Tumor Research Institute / Beijing Chest Hospital, Capital Medical University, Beijing, China
| | - Yongxiang Xu
- Department of Radiation Oncology, Beijing Tuberculosis and Thoracic Tumor Research Institute / Beijing Chest Hospital, Capital Medical University, Beijing, China
| | - Guangrong Xia
- Department of Radiation Oncology, Beijing Tuberculosis and Thoracic Tumor Research Institute / Beijing Chest Hospital, Capital Medical University, Beijing, China
| | - Tongmei Zhang
- Department of General Medicine, Beijing Tuberculosis and Thoracic Tumor Research Institute / Beijing Chest Hospital, Capital Medical University, Beijing, China
| | - Jiaqiang Huang
- Department of Cellular and Molecular Biology, Beijing Tuberculosis and Thoracic Tumor Research Institute / Beijing Chest Hospital, Capital Medical University, Beijing, China
| | - Hui Jiang
- Division of Technology, Beijing Tuberculosis and Thoracic Tumor Research Institute / Beijing Chest Hospital, Capital Medical University, Beijing, China
| | - Ji Ming Wang
- Laboratory of Cancer ImmunoMetabolism, Center for Cancer Research, National Cancer Institute at Frederick, Frederick, USA
| | - Baolan Li
- Department of General Medicine, Beijing Tuberculosis and Thoracic Tumor Research Institute / Beijing Chest Hospital, Capital Medical University, Beijing, China
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Jiang G, Huang J, Cui T, Lin X, Lin G. A biomarker-based prediction model for risk of locoregional recurrence in pathologic stage IIIA-N2 non-small cell lung cancer. INTERNATIONAL JOURNAL OF CLINICAL AND EXPERIMENTAL PATHOLOGY 2020; 13:3060-3082. [PMID: 33425107 PMCID: PMC7791370] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 07/15/2020] [Accepted: 10/30/2020] [Indexed: 06/12/2023]
Abstract
OBJECTIVE To investigate risk factors for locoregional recurrence (LRR) of pathologic stage IIIA-N2 non-small cell lung cancer (pIIIA-N2 NSCLC) and construct a prediction model for risk score to determine a patient's risk for LRR and guide the selection of postoperative radiotherapy (PORT). METHODS The clinical, pathologic, and biological data of 107 patients with pIIIA-N2 NSCLC treated at Fujian Provincial Hospital between May 2012 and December 2018 were analyzed retrospectively. None of the patients had positive surgical margins, and none received preoperative treatment or PORT. The Kaplan-Meier method was used for a univariate analysis of possible factors for locoregional recurrence-free survival (LRFS). The Cox regression model was used in a multivariate analysis to identify independent risk factors for LRFS, which were used to construct a prediction model for risk score. The concordance index was calculated to evaluate discrimination. RESULTS The median follow-up time was 31.2 months. During the follow-up, 69 (64.5%) patients had LRR and/or distant metastasis (DM). Among them, 46 (43%) patients had LRR (with or without DM), and 56 (52.3%) patients had DM (with or without LRR). The 1-year LRFS, distant metastasis-free survival, disease-free survival, and overall survival rates were 78.2%, 78%, 69.8%, and 90.2%, respectively; the 3-year rates were 50.6%, 41.2%, 31.2%, and 66.3%, respectively. Multivariate analysis showed that surgical approach (hazard ratio [HR], 0.348; 95% confidence interval [CI], 0.175-0.693; P = 0.003), metastatic N2 lymph node ratio (HR, 3.597; 95% CI, 1.832-7.062; P = 0.000), epidermal growth factor receptor status (HR, 3.666; 95% CI, 1.724-7.797; P = 0.001), and lymphocyte-to-monocyte ratio (HR, 2.364; 95% CI, 1.221-4.574; P = 0.011) were independent risk factors for LRFS. These independent risk factors were used to construct a prediction model for risk score and stratify patients into the low-risk group (risk score: 0-2), medium-risk group (risk score: 3-5), and high-risk group (risk score: 6-13). The 1-year LRFS rates of these groups were 91.9%, 85.3%, and 54.6%, respectively; the 3-year LRFS rates were 71.4%, 57.3%, and 13.6%, respectively. These between-group differences were significant (P = 0.000). The prediction model showed good discrimination (concordance index = 0.747, 95% CI, 0.678-0.816). CONCLUSION Our prediction model for risk score based on characteristics of pIIIA-N2 NSCLC patients may help clinicians predict a patient's risk for LRR. Further investigations of PORT with patients in different risk groups are warranted.
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Affiliation(s)
- Guicheng Jiang
- Department of Medical Oncology, Fujian Provincial Hospital, Provincial Clinical Medical College of Fujian Medical UniversityFuzhou 350001, Fujian, China
| | - Junpeng Huang
- Department of Medical Oncology, Fujian Provincial Hospital, Provincial Clinical Medical College of Fujian Medical UniversityFuzhou 350001, Fujian, China
| | - Tongjian Cui
- Department of Medical Oncology, Fujian Provincial Hospital, Provincial Clinical Medical College of Fujian Medical UniversityFuzhou 350001, Fujian, China
| | - Xing Lin
- Department of Thoracic Surgery, Fujian Provincial Hospital, Provincial Clinical Medical College of Fujian Medical UniversityFuzhou 350001, Fujian, China
| | - Guishan Lin
- Department of Medical Oncology, Fujian Provincial Hospital, Provincial Clinical Medical College of Fujian Medical UniversityFuzhou 350001, Fujian, China
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Xing H, Hu M, Chen J, Guo Y, Liu D, Liang C. Combining node location and node ratio as a prognostic factor for surgical resected non-small cell lung cancer: a population-based study. J Thorac Dis 2020; 12:3549-3560. [PMID: 32802434 PMCID: PMC7399421 DOI: 10.21037/jtd-20-758] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Background In the TNM system only the anatomic location is used to define nodal status. In this study we aim to evaluate the effectiveness of combining the location and ratio of metastatic lymph node (pN-NR) for the prognosis of non-small cell lung cancer (NSCLC). Methods Patients with pN1/pN2 NSCLC were retrieved from the SEER database. The optimal cut point of NR was determined with the maximal selecting test. All patients were divided into 4 categories with combination of pN (pN1 or pN2) and NR (low or high). The pN-NR was investigated as a predictor of overall survival (OS) and cause-specific survival (CSS) using Cox regression models. Survival curves were plotted using the Kaplan-Meier method and the difference was compared with log-rank test. Results A total of 12,170 patients were enrolled. The optimal cut point of NR was 0.3. Patients were divided into 4 groups: pN1-NR <0.3, pN1-NR ≥0.3, pN2-NR <0.3 and pN2-NR ≥0.3. The pN-NR was an independent prognostic factor for survival. Compared with pN1-NR <0.3, the hazard ratio of OS was 1.405 (95% CI: 1.295-1.524), 1.183 (95% CI: 1.113-1257) and 1.717 (95% CI: 1.607-1.835) times higher for pN1-NR ≥0.3, pN2-NR <0.3 and pN2-NR ≥0.3 group, respectively. The survival curves of OS separated well between the 4 pN-NR groups, with 5-year OS 47.1% for pN1-NR <0.3, 43.0% for pN2-NR <0.3, 35.0% for pN1-NR ≥0.3 and 28.5% for pN2-NR ≥0.3, and the P value between neighboring curves was statistically significantly. The same trend was observed for CSS. Subgroup analysis revealed similar results except the pneumonectomy group. Conclusions pN-NR could be a good predictor for the prognosis of NSCLC.
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Affiliation(s)
- Huajie Xing
- Department of Thoracic Surgery, China-Japan Friendship Hospital, Beijing, China
| | - Mengyu Hu
- Department of Breast Oncology, Beijing Cancer Hospital, Beijing, China
| | - Jingyu Chen
- Department of Thoracic Surgery, China-Japan Friendship Hospital, Beijing, China
| | - Yongqing Guo
- Department of Thoracic Surgery, China-Japan Friendship Hospital, Beijing, China
| | - Deruo Liu
- Department of Thoracic Surgery, China-Japan Friendship Hospital, Beijing, China
| | - Chaoyang Liang
- Department of Thoracic Surgery, China-Japan Friendship Hospital, Beijing, China
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Jin J, Xu Y, Hu X, Chen M, Fang M, Hang Q, Chen M. Postoperative radiotherapy option based on mediastinal lymph node reclassification for patients with pN2 non-small-cell lung cancer. ACTA ACUST UNITED AC 2020; 27:e283-e293. [PMID: 32669935 DOI: 10.3747/co.27.5899] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
Background In this research, we used the mediastinal lymph node reclassification proposed by the International Association for the Study of Lung Cancer (iaslc) to screen for patients with pathologic N2 (pN2) non-small-cell lung cancer (nsclc) who might benefit from postoperative radiotherapy (port). Methods The study enrolled 440 patients with pN2 nsclc who received complete surgical resection and allocated them to one of three groups: N2a1 (single-station skip mediastinal lymph node metastasis), N2a2 (single-station non-skip mediastinal lymph node metastasis), and N2b (multi-station mediastinal lymph node metastasis). Rates of local recurrence at first recurrence in patients receiving and not receiving port were compared using the chi-square test. Overall (os) and disease-free survival (dfs) were then compared using Kaplan-Meier survival analysis with log-rank test. In addition, the factors potentially influencing os and dfs were analyzed using univariate and multivariate Cox regression. Results The rate of local recurrence for the N2a2 and N2b groups was significantly lower in patients receiving port (p = 0.044 and p = 0.043 respectively). The log-rank test revealed that, for the N2a1 group, differences in os and dfs were not statistically significant between the patients who did and did not receive port (p = 0.304 and p = 0.197 respectively). For the N2a2 group, os and dfs were markedly superior in patients who received port compared with those who did not (p = 0.001 and p = 0.014 respectively). For the N2b group, os was evidently better in patients who received port compared with those who did not (p = 0.025), but no statistically significant difference in dfs was observed (p = 0.134). Multivariate regression analysis revealed that, in the N2a1 group, port was significantly associated with poor os [hazard ratio (hr): 2.618; 95% confidence interval (ci): 1.185 to 5.785; p = 0.017]; in the N2a2 group, port was associated with improved os (hr: 0.481; 95% ci: 0.314 to 0.736; p = 0.001) and dfs (hr: 0.685; 95% ci: 0.479 to 0.980; p = 0.039). Conclusions For patients with pN2 nsclc who receive complete resection, port might be beneficial only for patients with single-station non-skip metastasis (N2a2). Patients with single-station skip metastasis (N2a1) and multi-station metastasis (N2b) might not currently benefit from port.
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Affiliation(s)
- J Jin
- The 2nd Clinical Medical College of Zhejiang Chinese Medical University, Hangzhou, P.R.C.,Institute of Cancer and Basic Medicine, Chinese Academy of Science; Department of Radiation Oncology, Cancer Hospital of the University of Chinese Academy of Sciences; and Department of Radiation Oncology, Zhejiang Cancer Hospital, Hangzhou, P.R.C
| | - Y Xu
- Institute of Cancer and Basic Medicine, Chinese Academy of Science; Department of Radiation Oncology, Cancer Hospital of the University of Chinese Academy of Sciences; and Department of Radiation Oncology, Zhejiang Cancer Hospital, Hangzhou, P.R.C
| | - X Hu
- Institute of Cancer and Basic Medicine, Chinese Academy of Science; Department of Radiation Oncology, Cancer Hospital of the University of Chinese Academy of Sciences; and Department of Radiation Oncology, Zhejiang Cancer Hospital, Hangzhou, P.R.C
| | - M Chen
- The 2nd Clinical Medical College of Zhejiang Chinese Medical University, Hangzhou, P.R.C.,Institute of Cancer and Basic Medicine, Chinese Academy of Science; Department of Radiation Oncology, Cancer Hospital of the University of Chinese Academy of Sciences; and Department of Radiation Oncology, Zhejiang Cancer Hospital, Hangzhou, P.R.C
| | - M Fang
- Institute of Cancer and Basic Medicine, Chinese Academy of Science; Department of Radiation Oncology, Cancer Hospital of the University of Chinese Academy of Sciences; and Department of Radiation Oncology, Zhejiang Cancer Hospital, Hangzhou, P.R.C
| | - Q Hang
- The 2nd Clinical Medical College of Zhejiang Chinese Medical University, Hangzhou, P.R.C.,Institute of Cancer and Basic Medicine, Chinese Academy of Science; Department of Radiation Oncology, Cancer Hospital of the University of Chinese Academy of Sciences; and Department of Radiation Oncology, Zhejiang Cancer Hospital, Hangzhou, P.R.C
| | - M Chen
- Institute of Cancer and Basic Medicine, Chinese Academy of Science; Department of Radiation Oncology, Cancer Hospital of the University of Chinese Academy of Sciences; and Department of Radiation Oncology, Zhejiang Cancer Hospital, Hangzhou, P.R.C
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