Open AccessPreoperative radiation may improve the outcomes of resectable IIIA/N2 non‐small‐cell lung cancer patients: A propensity score matching‐based analysis from surveillance, epidemiology, and end results database
Author(s) -
Chen Dawei,
Wang Haiyong,
Song Xinyu,
Yue Jinbo,
Yu Jinming
Publication year - 2018
Publication title -
cancer medicine
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.403
H-Index - 53
ISSN - 2045-7634
DOI - 10.1002/cam4.1701
Subject(s) - medicine , propensity score matching , radiation therapy , stage (stratigraphy) , lung cancer , oncology , surveillance, epidemiology, and end results , subgroup analysis , epidemiology , surgery , cancer registry , meta analysis , paleontology , biology
Background There are several therapeutic strategies for the management of resectable stage IIIA /N2 non‐small‐cell lung cancer ( NSCLC ) patients. However, the role of radiotherapy as a preoperative adjuvant therapy is unclear. Methods We retrospectively analyzed the data of stage IIIA/N2 NSCLC patients who either underwent preoperative radiation (Pr ORT ), or did not undergo preoperative radiation, collected from the Surveillance, Epidemiology and End Results ( SEER ) database, between 2004 and 2013. The primary endpoints were cancer‐specific survival ( CSS ) and overall survival ( OS ). Results Ultimately, 493 patients treated with preoperative radiation and 2675 patients treated who were not treated with preoperative radiation, were included in the analysis. Overall, preoperative radiation was associated with a better CSS ( HR : 1.427 [1.297‐1.572], P = 0.014) and OS ( HR : 1.220 [1.131‐1.493], P = 0.002) than that observed in patients who did not undergo preoperative radiation. After PSM , preoperative radiation still showed advantage in both CSS and OS . Only age, T stage, and preoperative radiation remained independent prognostic factors for both OS and CSS . In the subgroup analysis, the advantages of preoperative radiotherapy were more pronounced in patients with stage T3 tumors and highly differentiated tumors. Conclusions Preoperative radiation may improve the outcomes of resectable IIIA/N2 NSCLC patients. In IIIA/N2 NSCLC patients, particularly with T3 and highly differentiated tumors, clinicians should boldly apply preoperative radiotherapy to improve the patients' survival.