Total ratio of lymph nodes and lymph nodes to determine indications

Researchers believed that postoperative radiotherapy (PORT) might increase overall survival (OS) in patients with pN2 NSCLC who have a high lymph node ratio (LNR). From 2004 to 2016, the National Cancer Database was searched for patients with non-metastatic pN2 NSCLC who underwent R0 surgery and adjuvant therapy. The influence of PORT and LNR on OS was assessed using Cox models that were adjusted for patient variables and treatment information. PORT was found in 1728 (42.7%) of 4050 patients. In patients who obtained PORT with known RT modality information, IMRT has been used more frequently in recent years (53.8% in 2010-2016 versus 24.0% in 2004-2009). Patients with higher LNR were more likely to achieve PORT (OR = 1.51 and 1.71, PPP= 0.058) in patients with insufficient lymph node dissection (LND). Patients with LNR less than 15% (HR = 1.11, P=0.21) or LNR 15-29% (HR=1.03, P=0.73) did not benefit from PORT, while those with LNR greater than or equal to 30% (HR=0.83, P=0.006) benefited. IMRT significantly increased OS in patients with LNR by more than or equal to 30% compared to no PORT (HR = 0.75, PP=0.32). After accounting for many variables, PORT was related to increased survival of patients with pN2 NSCLC after R0 resection, acceptable LND with high LNR. Patients with insufficient LND, excessive LNR, or use of IMRT accounted for the majority of OS benefit from PORT across the entire cohort. The role of adjuvant radiotherapy in patients with pathological N2 (pN2) non-small cell lung cancer (NSCLC) after adjuvant chemotherapy is a source of debate. The lymph node ratio (LNR) has been used to predict lung cancer survival. After adjuvant chemotherapy with high LNR or inadequate lymph node removal, researchers found that adjuvant radiation therapy, particularly intensity-modulated radiation therapy (IMRT), had survival benefits in patients with NSCLC pN2. These could be additional criteria for deciding who should receive adjuvant radiotherapy.


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