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@#Objective To systematically evaluate the efficacy of neoadjuvant chemoradiotherapy or chemotherapy followed by surgery versus definitive chemoradiation in stage ⅢA-N2 non-small cell lung cancer (NSCLC). Methods We searched PubMed, EMbase, Web of Science and The Cochrane Library to collect clinical studies on the efficacy comparison between neoadjuvant chemoradiotherapy or chemotherapy followed by surgery and definitive chemoradiation in stage ⅢA-N2 NSCLC from inception to September 2022. The meta-analysis was performed by using RevMan 5.3 software. Results A total of 9 studies (3 randomized controlled trials and 6 retrospective cohort studies) with 12 801 patients were included. The results of meta-analysis showed that there was no statistical difference in the progression-free survival rate between the inductive treatment followed by surgery (including lobectomy and pneumonectomy) and definitive chemoradiation (HR=0.99, 95%CI 0.86-1.15, P=0.91). Compared with definitive chemoradiation, the overall survival (OS) rate in the inductive treatment followed by surgery (including lobectomy and pneumonectomy) was lower (HR=1.24, 95%CI 1.09-1.42, P=0.001), while the OS rate in the inductive treatment followed by lobectomy was higher (HR=0.55, 95%CI 0.51-0.61, P<0.000 01). And the local recurrence rate in the inductive treatment followed by surgery was reduced (OR=0.44, 95%CI 0.36-0.55, P<0.000 01). Conclusion Neoadjuvant chemoradiotherapy or chemotherapy followed by lobectomy is superior to definitive chemoradiation in OS and it has a lower local recurrence rate, so lobectomy should be one of the multidisciplinary treatments for selected ⅢA-N2 NSCLC patients.
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Non-small cell lung cancer(NSCLC) is highly malignant and has poor prognosis, in which stage ⅢA(N 2) NSCLC approximately accounts for 20%. Patients with stage ⅢA(N 2) NSCLC have high heterogeneity and distinct survival difference. Loco-regional recurrence and distant metastasis are the main causes of treatment failure. At present, whether stage ⅢA(N 2) NSCLC patients should receive postoperative radiotherapy(PORT) remains controversial. Such patients still lack high level proof to receive PORT.
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Background and purpose: The prognosis of completely resected stage ⅢA(N2) non-small cell lung cancer (NSCLC) remains a significant concern. The 5-year overall survival (OS) rates range from 10% to 30%. This study aimed to analyze the patterns of first failure in completely resected stage ⅢA(N2) NSCLC and to assess the actuarial risk of developing metastasis at different sites and to guild standard clinical practice. Methods: Patients withⅢA(N2) NSCLC who had undergone radical surgery in our hospital from Jan. 2005 to Jul. 2012 were retrospectively reviewed. The progression-free survival (PFS), the OS, patterns of first failure, the actuarial risk were analyzed. The cumulative incidence of first failure was determined using the Kaplan-Meier analysis. Results: Among 357 patients who met the eligibility criteria with completely resected stage ⅢA(N2) NSCLC, 5-year OS was 36.9%. There were 284 (77.6%) patients experiencing disease failure: 61 with local failure, 197 with local and distant failures, and 26 patients with local recurrence as the first failure. Brain, bone and lung were the main sites of distant failure as the first failure, while brain was the most common site. There were 67 patients developing brain metastases (BM) as the first site of failure. The median time of local failure as the first site of failure was 13.6 months, and the time to develop distant recurrence was 15.1 months. 92.5% BM developed in 3 years after the complete resection. Conclusion: As the first failure, the rate of distant failure was much higher than that of local failure in completely resected stage ⅢA(N2) NSCLC. Brain was the most common site of distant failure as the first failure. These results can be helpful in guiding standard clinical practice and evaluating the outcome of comprehensive treatment.
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Objective:This paper will retrospectively analyze the long-term results of PORT for Completely Resected Stage Ⅲa(N2) NSCLC.The strategies of treatment are also to be discussed.Methods:92 cases with Completely Resected Stage Ⅲa(N2)NSCLC treated in our hospital from 1987 to 2004 were analyzed.Among them,46 patients received PORT(Group S+R),46 no PORT(Group S).39 of the entire patients。received chemotherapy.Median radiation dose was 56 Gy(40～64 Gy).The survival rates were analyzed and compared by Kaplan-Meier and Log-rank.Results:(1)The 5 and 10-year overall survival(OS) for all patients was 44.5% and 30.4%,respectively(.2)The 5 and 10-year OS of group S+R and S was 49.1% vs 36.5% and 36.3% vs 25.4%,respectively,with no significant difference(?2=0.83,P=0.65)(.3)For the patients with single station involved N2,PORT tends to improve the disease-free survival(DFS) but no reach significant difference.As for patients with multiple stations involved N2,PORT could improve the DFS,the 5 and 10-year DFS of group S+R and S was 40.6% vs.4.5%;21.2% vs.4.1%,respectively,(?2=4.35,P=0.03),meanwhile,it might increase the OS(.4) The survival rate treated with PORT from 1996 to 2004 was higher than that from 1987 to 1995,(?2=4.28,P=0.04)(.5)Recurrence was seen in 63% of patients.The total(both local/regional recurrence and distant metastasis)and local/regional recurrenc rate of group S+R was lower than that of group S,i.e.50.0% vs76.1%(?2=6.72,P=0.001)and 8.7% vs 32.6%(?2=8.03,P=0.001),respectively.Distant metastasis was found to be the main failure cause for both group S+R and S.Multivariate analyses showed that age and number of mediastinal lymph node station involved have influence on the survival of patients with Completely Resected Stage Ⅲa(N2)NSCLC.the DFS.But its value for patients with single station involved N2 was unclear and a further randomized clinical trail is still warrant.(2)Age and the number of mediastinal lymph node station involved are the two significant prognosis factors for patients with Completely Resected Stage Ⅲa(N2)NSCLC(.3)Condition of equipment and radiation technology used could have some influence on the result of PORT(.4)The fact that distant metastasis was the main failure cause for both group S+R and S might imply that patients with Completely Resected Stage Ⅲa(N2)NSCLC might benefit from chemotherapy.It suggests thus that chemotherapy should be considered for these patients.