The impact of EGFR mutation and PD-L1 status on the efficacy of postoperative radiotherapy in stage III-pN2 NSCLC
Abstract Background The role of postoperative radiotherapy (PORT) for patients with completely resected stage III-pN2 non-small-cell lung cancer (NSCLC) remains controversial. PORT is not routinely recommended for patients with completely resected stage III-pN2 NSCLC. Therefore, identifying the popu...
Saved in:
| Main Authors: | , , , , |
|---|---|
| Format: | Article |
| Language: | English |
| Published: |
BMC
2025-05-01
|
| Series: | BMC Cancer |
| Subjects: | |
| Online Access: | https://doi.org/10.1186/s12885-025-14255-0 |
| Tags: |
Add Tag
No Tags, Be the first to tag this record!
|
| _version_ | 1850133360844734464 |
|---|---|
| author | Jinquan Yao Yuxin Geng Junhao Xu Bingwen Zou Feifei Teng |
| author_facet | Jinquan Yao Yuxin Geng Junhao Xu Bingwen Zou Feifei Teng |
| author_sort | Jinquan Yao |
| collection | DOAJ |
| description | Abstract Background The role of postoperative radiotherapy (PORT) for patients with completely resected stage III-pN2 non-small-cell lung cancer (NSCLC) remains controversial. PORT is not routinely recommended for patients with completely resected stage III-pN2 NSCLC. Therefore, identifying the population that could benefit from PORT is urgently needed. Methods We retrospectively enrolled 251 patients with completely resected stage III-pN2 NSCLC at our institution between 2018 and 2023. The Kaplan–Meier curves and log-rank tests were used to analyze disease-free survival (DFS) and overall survival (OS). Risk factors were identified using univariate and multivariate Cox regression analyses. The cumulative incidence rates of locoregional recurrence (LRR) were calculated via competing risk analyses and compared using the Gray test. Results A total of 251 patients were enrolled in the study, with the median follow-up of 24.9 months. Among overall patients, 61 patients underwent PORT, and 190 patients did not. Although patients in the PORT group exhibited a trend toward longer DFS, the difference was not statistically significant (median DFS: 39.1 vs. 35.5 months; HR 0.58, 95% CI 0.35–0.97; p = 0.072). Subgroup analyses revealed that PORT significantly prolonged DFS both in EGFR wild-type patients (median DFS: 35.3 vs. 18.3 months; HR 0.33, 95% CI 0.17–0.62; p = 0.002) and in PD-L1 positive patients (median DFS: 35.3 vs.16.4 months; HR 0.35, 95% CI 0.16–0.74; p = 0.029). In contrast, no significant DFS or OS benefits were observed in EGFR mutant patients or PD-L1 negative patients. Furthermore, PORT was associated with the significantly lower risk of LRR in overall patients (HR 0.39, 95% CI 0.16–0.97; p = 0.043), EGFR wild-type patients (HR 0.25, 95% CI 0.09–0.68; p = 0.007), and PD-L1 positive patients (HR 0.15, 95% CI 0.03–0.70; p = 0.016). PORT did not confer a locoregional control benefit in EGFR mutant patients (HR 0.58, 95% CI 0.07–4.58; p = 0.61) or PD-L1 negative patients (HR 1.02, 95% CI 0.27–3.82; p = 0.98). Conclusion For patients with completely resected stage III-pN2 NSCLC, PORT significantly improves DFS and reduces the risk of LRR in EGFR wild-type patients or PD-L1 positive patients. The EGFR and PD-L1 status may serve as biomarkers to identify the population that could benefit from PORT. |
| format | Article |
| id | doaj-art-97a9bb312a0f4222895a1a2772d3670e |
| institution | OA Journals |
| issn | 1471-2407 |
| language | English |
| publishDate | 2025-05-01 |
| publisher | BMC |
| record_format | Article |
| series | BMC Cancer |
| spelling | doaj-art-97a9bb312a0f4222895a1a2772d3670e2025-08-20T02:31:59ZengBMCBMC Cancer1471-24072025-05-0125111210.1186/s12885-025-14255-0The impact of EGFR mutation and PD-L1 status on the efficacy of postoperative radiotherapy in stage III-pN2 NSCLCJinquan Yao0Yuxin Geng1Junhao Xu2Bingwen Zou3Feifei Teng4Department of Radiation Oncology, Shandong Provincial Key Laboratory of Radiation Oncology, Shandong Cancer Hospital and Institute, Shandong First Medical University, Shandong Academy of Medical SciencesDepartment of Radiation Oncology, Shandong Provincial Key Laboratory of Radiation Oncology, Shandong Cancer Hospital and Institute, Shandong First Medical University, Shandong Academy of Medical SciencesDepartment of Outpatient Chemotherapy, Harbin Medical University Cancer HospitalDepartment of Radiation Oncology, West China Hospital of Sichuan UniversityDepartment of Radiation Oncology, Shandong Provincial Key Laboratory of Radiation Oncology, Shandong Cancer Hospital and Institute, Shandong First Medical University, Shandong Academy of Medical SciencesAbstract Background The role of postoperative radiotherapy (PORT) for patients with completely resected stage III-pN2 non-small-cell lung cancer (NSCLC) remains controversial. PORT is not routinely recommended for patients with completely resected stage III-pN2 NSCLC. Therefore, identifying the population that could benefit from PORT is urgently needed. Methods We retrospectively enrolled 251 patients with completely resected stage III-pN2 NSCLC at our institution between 2018 and 2023. The Kaplan–Meier curves and log-rank tests were used to analyze disease-free survival (DFS) and overall survival (OS). Risk factors were identified using univariate and multivariate Cox regression analyses. The cumulative incidence rates of locoregional recurrence (LRR) were calculated via competing risk analyses and compared using the Gray test. Results A total of 251 patients were enrolled in the study, with the median follow-up of 24.9 months. Among overall patients, 61 patients underwent PORT, and 190 patients did not. Although patients in the PORT group exhibited a trend toward longer DFS, the difference was not statistically significant (median DFS: 39.1 vs. 35.5 months; HR 0.58, 95% CI 0.35–0.97; p = 0.072). Subgroup analyses revealed that PORT significantly prolonged DFS both in EGFR wild-type patients (median DFS: 35.3 vs. 18.3 months; HR 0.33, 95% CI 0.17–0.62; p = 0.002) and in PD-L1 positive patients (median DFS: 35.3 vs.16.4 months; HR 0.35, 95% CI 0.16–0.74; p = 0.029). In contrast, no significant DFS or OS benefits were observed in EGFR mutant patients or PD-L1 negative patients. Furthermore, PORT was associated with the significantly lower risk of LRR in overall patients (HR 0.39, 95% CI 0.16–0.97; p = 0.043), EGFR wild-type patients (HR 0.25, 95% CI 0.09–0.68; p = 0.007), and PD-L1 positive patients (HR 0.15, 95% CI 0.03–0.70; p = 0.016). PORT did not confer a locoregional control benefit in EGFR mutant patients (HR 0.58, 95% CI 0.07–4.58; p = 0.61) or PD-L1 negative patients (HR 1.02, 95% CI 0.27–3.82; p = 0.98). Conclusion For patients with completely resected stage III-pN2 NSCLC, PORT significantly improves DFS and reduces the risk of LRR in EGFR wild-type patients or PD-L1 positive patients. The EGFR and PD-L1 status may serve as biomarkers to identify the population that could benefit from PORT.https://doi.org/10.1186/s12885-025-14255-0Postoperative radiotherapyNon-small cell lung cancerPathologic N2Epidermal growth factor receptorProgrammed death-ligand 1 |
| spellingShingle | Jinquan Yao Yuxin Geng Junhao Xu Bingwen Zou Feifei Teng The impact of EGFR mutation and PD-L1 status on the efficacy of postoperative radiotherapy in stage III-pN2 NSCLC BMC Cancer Postoperative radiotherapy Non-small cell lung cancer Pathologic N2 Epidermal growth factor receptor Programmed death-ligand 1 |
| title | The impact of EGFR mutation and PD-L1 status on the efficacy of postoperative radiotherapy in stage III-pN2 NSCLC |
| title_full | The impact of EGFR mutation and PD-L1 status on the efficacy of postoperative radiotherapy in stage III-pN2 NSCLC |
| title_fullStr | The impact of EGFR mutation and PD-L1 status on the efficacy of postoperative radiotherapy in stage III-pN2 NSCLC |
| title_full_unstemmed | The impact of EGFR mutation and PD-L1 status on the efficacy of postoperative radiotherapy in stage III-pN2 NSCLC |
| title_short | The impact of EGFR mutation and PD-L1 status on the efficacy of postoperative radiotherapy in stage III-pN2 NSCLC |
| title_sort | impact of egfr mutation and pd l1 status on the efficacy of postoperative radiotherapy in stage iii pn2 nsclc |
| topic | Postoperative radiotherapy Non-small cell lung cancer Pathologic N2 Epidermal growth factor receptor Programmed death-ligand 1 |
| url | https://doi.org/10.1186/s12885-025-14255-0 |
| work_keys_str_mv | AT jinquanyao theimpactofegfrmutationandpdl1statusontheefficacyofpostoperativeradiotherapyinstageiiipn2nsclc AT yuxingeng theimpactofegfrmutationandpdl1statusontheefficacyofpostoperativeradiotherapyinstageiiipn2nsclc AT junhaoxu theimpactofegfrmutationandpdl1statusontheefficacyofpostoperativeradiotherapyinstageiiipn2nsclc AT bingwenzou theimpactofegfrmutationandpdl1statusontheefficacyofpostoperativeradiotherapyinstageiiipn2nsclc AT feifeiteng theimpactofegfrmutationandpdl1statusontheefficacyofpostoperativeradiotherapyinstageiiipn2nsclc AT jinquanyao impactofegfrmutationandpdl1statusontheefficacyofpostoperativeradiotherapyinstageiiipn2nsclc AT yuxingeng impactofegfrmutationandpdl1statusontheefficacyofpostoperativeradiotherapyinstageiiipn2nsclc AT junhaoxu impactofegfrmutationandpdl1statusontheefficacyofpostoperativeradiotherapyinstageiiipn2nsclc AT bingwenzou impactofegfrmutationandpdl1statusontheefficacyofpostoperativeradiotherapyinstageiiipn2nsclc AT feifeiteng impactofegfrmutationandpdl1statusontheefficacyofpostoperativeradiotherapyinstageiiipn2nsclc |