Patient prognostic scores and association with survival improvement offered by postoperative radiotherapy for resected IIIA/N2 non‐small cell lung cancer: A population‐based study

• Main Authors: Lei Xu, Hou‐nai Xie, Xian‐kai Chen, Nan Bi, Jian‐jun Qin, Yin Li
• Format: Article
• Language: English
• Published: Wiley 2021-03-01
• Series: Thoracic Cancer
• Subjects: cancer‐specific mortality; non‐small cell lung cancer; patient prognostic scores; postoperative radiation; stage IIIA/N2
• Online Access: https://doi.org/10.1111/1759-7714.13835

Abstract Background Currently, there is no consensus on the role of postoperative adjuvant radiotherapy (PORT) for resected stage IIIA/N2 non‐small cell lung cancer (NSCLC). Our study sought to determine which patients may be able to benefit from PORT, based on a patient prognostic score. Methods A retrospective cohort study was conducted to identify patients diagnosed with IIIA/N2 NSCLC between 1988 and 2016 in the SEER database. Eligible patients were divided into the following two groups: PORT group and non‐PORT group. We classified patient prognostic scores as an ordinal factor and stratified patients based on prognostic scores. A Cox proportional hazards model with propensity score weighting was performed to evaluate cancer‐specific mortality (CSM) between the two groups. Results We identified 7060 eligible patients with IIIA/N2 NSCLC, 2833 (40.1%) in the PORT group and 4227 (59.9%) in the non‐PORT group. Overall, the 10‐year CSM rate in the weighted cohorts was 70.4% in the PORT group, 72.0% in the non‐PORT group, and patients who received PORT had a lower CSM rate (p = 0.001). Compared with the non‐PORT group, significant survival improvements in the PORT group were observed in patients with higher age, grade, T stage and lymph node ratio (LNR), and without chemotherapy. The improved survival of patients receiving PORT was significantly correlated with patient prognostic scores (p < 0.001). Conclusions In our population‐based study, the prognostic score was associated with the survival improvement offered by PORT in IIIA/N2 NSCLC, suggesting that prognostic scores and clinicopathological characteristics may be helpful in proper candidate selection for PORT.