| Purpose:Lung cancer is the leading cause of cancer-related deaths worldwide,and non-small cell lung cancer(NSCLC)accounts for approximately 85% of all lung cancer cases,with stage ⅢA N2 NSCLC being a potentially curable disease at the stage of elective resection.Although treatment by surgery can provide survival benefits for this group of patients,the high rate of recurrence after surgery remains a major obstacle to long-term patient survival.The aim of this paper is to provide a comprehensive overview of the factors associated with postoperative recurrence of stage ⅢA N2 non-small cell lung cancer,with the objective of identifying potential strategies to reduce the risk of recurrence and improve patient prognosis.Methods:The clinical data of 124 patients with postoperative pathology of stage ⅢAN2non-small cell lung cancer in the First Hospital of Guangzhou Medical University between January 1,2018 and September 1,2022 were retrospectively analyzed,and the data were collected through postoperative outpatient review or telephone follow-up,and 87 eligible patients were finally included after screening and exclusion.Independent prognostic factors for patients with stage ⅢA N2 postoperative NSCLC were analysed using the IBM SPSS 25 program,with variables included in a single-factor Cox regression analysis first,and each single factor that was statistically significant(p < 0.05)and clinically relevant studies that considered meaningful factors that might affect prognosis were included together in a Cox risk regression model for multifactor analysis,and the screened independent risk factors were plotted in Cox regression forest plots.The differences in prognosis between different treatment subgroups were compared by Kaplan-Meier method subgroup analysis and tested by log-rank method.p < 0.05 was defined as statistically significant.RESULTS:A total of 87 patients were included in this study,of whom 40(46%)were male and 47(54%)were female,with an age range of 24-85 years,a mean age of 57.7years and a median age of 56 years.The median follow-up time was 15.77 months,with a mean follow-up time of 17 months.A total of 36 patients recurred within 3years,with a 3-year recurrence rate of 41.38%.The postoperative pathology was adenocarcinoma in 68 cases,squamous carcinoma in 8 cases,lymphoepithelioma-like carcinoma in 7 cases and large cell carcinoma in 4 cases.The maximum tumour diameter ranged from 0.8-4.6 cm with a mean of 2.96 cm.univariate analysis showed that factors such as choroidal carcinoma thrombosis(p=0.022 <0.05)and treatment regimen(p=0.001 <0.05)were associated with postoperative recurrence of stage ⅢAN2 non-small cell lung cancer.Further inclusion of the above two factors and three independent variables(Airspace dissemination、PL grading and lymph node type)that were not statistically different at univariate analysis but were clinically considered to be closely related to the dependent variable in the Cox multifactorial analysis showed that tumour invasion reaching the pleural surface(p=0.001),postoperative lymph node staging of p N2b(p=0.041)and postoperative adjuvant treatment regimen(p=0.0001)were independent risk factors for recurrence of stage ⅢAN2 non-small cell lung cancer(p < 0.05).Forest plots were drawn based on the results of Cox multifactorial analysis.Recurrence-free survival rates between different postoperative adjuvant treatments were analysed by the Kaplan-Meier method and statistical differences were tested by the Log-rank method.The results showed that those who received targeted therapy after surgery had a longer disease-free survival than those who did not(p=0.005).Conclusions:1.Tumour invasion reaching the pleural surface(p=0.001),postoperative lymph node staging as p N2b(p=0.041)and postoperative adjuvant treatment regimen(p=0.0001)were independent risk factors for recurrence of stage ⅢAN2 non-small cell lung cancer.2.Forest plots visualised the risk ratios for each prognostic factor.3.In adjuvant therapy for post-operative patients with stage ⅢA N2,disease-free survival was significantly better in those containing the driver gene target and receiving targeted therapy than in those not receiving targeted therapy(p=0.005). |
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