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Published on: July 28, 2020
Comparative effectiveness of different adjuvant therapy modalities for stage IIIA-N2 non-small cell lung cancer
Bin Li1, Hao Yang1, Hongchao Li1
1Department of Cardiothoracic Surgery, Xinxiang Central Hospital, The Fourth Clinical College of Henan Medical University Xinxiang, Henan, China.
Background:
The optimal adjuvant strategy for completely resected stage IIIA-N2 non-small cell lung cancer (NSCLC) remains debated. While adjuvant chemotherapy (ACT) is standard, the added value of radiotherapy (RT) - and the optimal modality of integration (concurrent [ACRT] vs. sequential [ACT+RT]) - are uncertain. This study compared the long-term effectiveness of different adjuvant modalities.
Methods:
In this single-center retrospective cohort study, 247 patients with completely resected (R0) pathological stage IIIA-N2 NSCLC (2015-2020) were categorized by treatment received: Observation (n=37), ACT (n=86), ACRT (n=53), or ACT+RT (n=71). Primary endpoints were overall survival (OS) and disease-free survival (DFS). Multivariable Cox regression adjusted for key confounders (e.g., N2 station number, extracapsular extension).
Results:
With median follow-up of 52.3 months, multivariable analysis showed ACRT (HR=0.41, 95% CI: 0.26-0.64), ACT+RT (HR=0.49, 95% CI: 0.32-0.75), and ACT (HR=0.66, 95% CI: 0.44-0.99) were independently associated with improved OS versus Observation (all P<0.05). For DFS, all active treatments were superior to Observation; ACRT showed a trend over ACT alone (HR=0.43 vs. 0.63). OS and DFS did not differ significantly between ACRT and ACT+RT. The ACRT group had the highest locoregional control (failure rate: 17.0% vs. 22.1-27.0% in others) but also the highest grade ≥3 toxicity (54.7%, primarily radiation esophagitis/pneumonitis), while ACT+RT had lower toxicity (39.4%).
Conclusion:
For completely resected stage IIIA-N2 NSCLC, adjuvant regimens incorporating radiotherapy (ACRT or ACT+RT) are associated with superior survival outcomes compared to ACT alone or observation. The comparable efficacy but more favorable toxicity profile of the sequential approach suggests it may be a viable option, particularly for patients at risk for additive toxicities. These real-world discoveries provide a basis for the local systemic combined treatment of the high-risk population.