应用倾向评分匹配法评价ⅢA-N2期非小细胞肺癌术后放疗的价值

韩玮; 乔学英; 付丽媛; 葛雪珂; 白文文

doi:10.3971/j.issn.1000-8578.2017.02.007

应用倾向评分匹配法评价ⅢA-N2期非小细胞肺癌术后放疗的价值

Evaluation of Postoperative Radiotherapy after Curative Resection in ⅢA-N2 Non-small Cell Lung Cancer with Propensity Score Matching Analysis

摘要

摘要:
目的分析ⅢA-N2期非小细胞肺癌根治术后辅助放疗（postoperative radiotherapy, PORT）的作用。
方法收集313例非小细胞肺癌根治术后化疗后的ⅢA-N2期患者的临床资料，对PORT（+）组及PORT（-）组资料应用倾向评分匹配方法均衡组间协变量差异，观察两组生存及局控，分析术后放疗的作用及获益人群。
结果匹配后两组患者中，PORT（+）组与PORT（-）组3、5年生存率分别为76.5%、58.3%和52.1%、40.6%（P=0.162）；3、5年局部控制率分别为82.9%、73.7%和56.5%、42.4%（P=0.036）；3、5年无进展生存率分别为74.8%、65.5%和39.5%、29.6%（P=0.021）。分层分析发现术后放疗可降低隆突下淋巴结转移、肿瘤最大径≥3cm、多站转移、非跳跃转移及术前N2亚组的局部复发风险。
结论术后放疗可提高ⅢA-N2期非小细胞肺癌术后化疗后局部控制率及无进展生存率；亚组分析中隆突下淋巴结转移、肿瘤最大径≥3 cm、多站转移、非跳跃转移及术前N2者获益较大。

Abstract:
Objective To investigate the role of postoperative radiotherapy in the patients treated with curative surgery and adjuvant chemotherapy in stage ⅢA-N2 non-small cell lung cancer (NSCLC).
Methods The clinical data of 313 patients pathologically diagnosed as stage ⅢA-N2 NSCLC with curative resection and adjuvant chemotherapy were retrospectively analyzed. Propensity score matching analysis was used to balance the variables differences. The survival and patterns of failure were observed. The role of postoperative radiotherapy and the subgroups that benefited from postoperative radiotherapy were analyzed.
Results After propensity scores matching, the 3- and 5-year overall survival rates of PORT(+) and PORT(-) were 76.5%, 58.3% and 52.1%, 40.6%, respectively (P=0.162). The 3- and 5-year locoregional control rates of PORT(+) and PORT(-) were 82.9%, 73.7% and 56.5%, 42.4%, respectively (P=0.036). The 3- and 5-year progression-free survival rates of PORT(+) and PORT(-) were 74.8%, 65.5% and 39.5%, 29.6%, respectively (P=0.021). Subgroups analyses suggested that the patients with involvement of subcarinal lymph nodes, tumor diameter≥3cm, multiple N2 metastases, nonskip N2 metastasis and clinical N2 status, and PORT was associated with improved locoregional control rates.
Conclusion PORT could increase the local-regional control rate and progression-free survival rate in stage ⅢA-N2 NSCLC with curative resection and adjuvant chemotherapy; Patients with involvement of subcarinal lymph nodes , tumor diameter≥3cm, multiple N2 metastases, nonskip N2 metastasis and clinical N2 status may benefit most from PORT.

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