{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,4,7]],"date-time":"2026-04-07T14:21:07Z","timestamp":1775571667339,"version":"3.50.1"},"reference-count":31,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2025,2,4]],"date-time":"2025-02-04T00:00:00Z","timestamp":1738627200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Surg."],"abstract":"<jats:sec><jats:title>Objective<\/jats:title><jats:p>Non-small cell lung cancer (NSCLC) constitutes approximately 85% of lung cancer cases, with 20%\u201330% of patients diagnosed at stage III. While multimodal therapy is the standard for treating locally advanced NSCLC, the role of PORT remains controversial. This study seeks to evaluate the effect of postoperative radiotherapy (PORT) on overall survival (OS) and cancer-specific survival (CSS) in patients with resected pathologic N2 (pN2) stage IIIA NSCLC.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>Data from the Surveillance, Epidemiology, and End Results Program (SEER) 17 registry (2010\u20132019) were analyzed. The cohort included 1,471 patients aged 65 years or older, diagnosed with stage IIIA pN2 NSCLC, who had undergone lobectomy or total pneumonectomy. Patients who had received neoadjuvant chemotherapy or radiotherapy were excluded. Univariate and multivariate analyses were conducted to assess the association of PORT with OS and CSS. Kaplan-Meier survival curves were employed to estimate survival outcomes, while the COX proportional hazards model was utilized for comparative analysis. PLN counts were stratified into two categories: \u22641 and &amp;gt;1.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Among the 1,471 patients included in the study, 613 (41.67%) received PORT, while 858 (58.33%) did not. PORT was associated with a significantly higher 1- and 3-year OS (89.96% and 68.49%, respectively) compared to the non-PORT group (87.44% and 61.88%, respectively, <jats:italic>P<\/jats:italic>\u2009=\u20090.03). However, no significant difference in CSS was observed between the groups (<jats:italic>P<\/jats:italic>\u2009=\u20090.15). Among patients with PLN counts &amp;gt;1, PORT significantly improved OS (HR\u2009=\u20091.32, 95% CI\u2009=\u20091.04\u20131.68, <jats:italic>P<\/jats:italic>\u2009=\u20090.0016) and CSS (HR\u2009=\u20091.32, 95% CI\u2009=\u20090.99\u20131.70, <jats:italic>P<\/jats:italic>\u2009=\u20090.026), whereas no significant differences were seen in patients with PLN counts \u22641.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>This study underscores the potential of PORT in enhancing OS in patients with resectable pN2 stage IIIA NSCLC, particularly in those with PLN counts exceeding one. These findings suggest that PORT may offer improved outcomes in patients with extensive lymph node involvement, emphasizing the need for further prospective studies to validate and expand upon these observations.<\/jats:p><\/jats:sec>","DOI":"10.3389\/fsurg.2024.1506854","type":"journal-article","created":{"date-parts":[[2025,2,4]],"date-time":"2025-02-04T06:33:40Z","timestamp":1738650820000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":1,"title":["Postoperative radiotherapy improves survival in completely resected non-small cell lung cancer with pathologic N2 stage IIIA and positive lymph node count greater than one: a SEER-based retrospective cohort study"],"prefix":"10.3389","volume":"11","author":[{"given":"Diyang","family":"Zhu","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Yuanyuan","family":"Xiao","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Shancheng","family":"He","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Baochang","family":"Xie","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Wenqi","family":"Zhao","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Yuhui","family":"Xu","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1965","published-online":{"date-parts":[[2025,2,4]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","first-page":"10","DOI":"10.1016\/j.ctrv.2016.10.001","article-title":"Postoperative radiotherapy for lung cancer: is it worth the controversy?","volume":"51","author":"Billiet","year":"2016","journal-title":"Cancer Treat Rev"},{"key":"B2","doi-asserted-by":"publisher","first-page":"iv1","DOI":"10.1093\/annonc\/mdx222","article-title":"Early and locally advanced non-small-cell lung cancer (NSCLC): ESMO clinical practice guidelines for diagnosis, treatment and follow-up","volume":"28","author":"Postmus","year":"2017","journal-title":"Ann Oncol"},{"key":"B3","doi-asserted-by":"publisher","first-page":"254","DOI":"10.6004\/jnccn.2021.0013","article-title":"NCCN guidelines insights: non-small cell lung cancer, version 2.2021","volume":"19","author":"Ettinger","year":"2021","journal-title":"J Natl Compr Canc Netw"},{"key":"B4","doi-asserted-by":"publisher","first-page":"l1049","DOI":"10.1136\/bmj.l1049","article-title":"Lung cancer: diagnosis and management: summary of updated NICE guidance","volume":"364","author":"Maconachie","year":"2019","journal-title":"BMJ"},{"key":"B5","doi-asserted-by":"publisher","first-page":"220","DOI":"10.1183\/23120541.00159-2019","article-title":"International guidelines on stage III N2 nonsmall cell lung cancer: surgery or radiotherapy?","volume":"6","author":"Putora","year":"2020","journal-title":"ERJ Open Res"},{"key":"B6","doi-asserted-by":"publisher","first-page":"41670","DOI":"10.18632\/oncotarget.16471","article-title":"Definitive radiochemotherapy versus surgery within multimodality treatment in stage III non-small cell lung cancer (NSCLC) - a cumulative meta-analysis of the randomized evidence","volume":"8","author":"P\u00f6ttgen","year":"2017","journal-title":"Oncotarget"},{"key":"B7","doi-asserted-by":"publisher","first-page":"3552","DOI":"10.1200\/JCO.2007.13.9030","article-title":"Lung adjuvant cisplatin evaluation: a pooled analysis by the LACE collaborative group","volume":"26","author":"Pignon","year":"2008","journal-title":"J Clin Oncol"},{"key":"B8","doi-asserted-by":"publisher","first-page":"2981","DOI":"10.1200\/JCO.2000.18.16.2981","article-title":"Survival of patients with resected N2 non-small-cell lung cancer: evidence for a subclassification and implications","volume":"18","author":"Andre","year":"2000","journal-title":"J Clin Oncol"},{"key":"B9","doi-asserted-by":"publisher","first-page":"329","DOI":"10.1016\/j.lungcan.2006.10.024","article-title":"Analyses on prognostic factors following tri-modality therapy for stage IIIa non-small cell lung cancer","volume":"55","author":"Kim","year":"2007","journal-title":"Lung Cancer"},{"key":"B10","doi-asserted-by":"publisher","first-page":"33","DOI":"10.1016\/j.ejcts.2005.03.016","article-title":"Prognostic factors in surgically resected N2 non-small cell lung cancer: the importance of patterns of mediastinal lymph nodes metastases","volume":"28","author":"Casali","year":"2005","journal-title":"Eur J Cardiothorac Surg"},{"key":"B11","doi-asserted-by":"publisher","first-page":"3","DOI":"10.1016\/j.radonc.2013.08.011","article-title":"Modern post-operative radiotherapy for stage III non-small cell lung cancer may improve local control and survival: a meta-analysis","volume":"110","author":"Billiet","year":"2014","journal-title":"Radiother Oncol"},{"key":"B12","doi-asserted-by":"publisher","first-page":"156","DOI":"10.1016\/j.lungcan.2014.02.016","article-title":"Evidence supporting contemporary post-operative radiation therapy (PORT) using linear accelerators in N2 lung cancer","volume":"84","author":"Patel","year":"2014","journal-title":"Lung Cancer"},{"key":"B13","doi-asserted-by":"publisher","first-page":"343","DOI":"10.1007\/s11864-009-0090-8","article-title":"Post-operative radiation therapy (PORT) in completely resected non-small-cell lung cancer","volume":"9","author":"Krupitskaya","year":"2008","journal-title":"Curr Treat Options Oncol"},{"key":"B14","doi-asserted-by":"crossref","first-page":"94","DOI":"10.1007\/978-1-84628-474-8_11","article-title":"Adjuvant postoperative therapy for completely resected stage I lung cancer","volume-title":"Difficult Decisions in Thoracic Surgery: An Evidence-Based Approach","author":"D\u2019Amato","year":"2007"},{"key":"B15","doi-asserted-by":"crossref","first-page":"363","DOI":"10.1007\/174_2011_315","article-title":"Postoperative radiotherapy for non-small cell carcinoma","volume-title":"Advances in Radiation Oncology in Lung Cancer","author":"Kim","year":"2011"},{"key":"B16","doi-asserted-by":"publisher","first-page":"Cd002142","DOI":"10.1002\/14651858.CD002142.pub4","article-title":"Postoperative radiotherapy for non-small cell lung cancer","volume":"10","author":"Burdett","year":"2016","journal-title":"Cochrane Database Syst Rev"},{"key":"B17","doi-asserted-by":"publisher","first-page":"695","DOI":"10.1016\/j.ijrobp.2008.01.044","article-title":"Impact of postoperative radiation therapy on survival in patients with complete resection and stage I, II, or IIIA non-small-cell lung cancer treated with adjuvant chemotherapy: the Adjuvant Navelbine International Trialist Association (ANITA) randomized trial","volume":"72","author":"Douillard","year":"2008","journal-title":"Int J Radiat Oncol Biol Phys"},{"key":"B18","doi-asserted-by":"publisher","first-page":"310","DOI":"10.1007\/s12262-009-0086-4","article-title":"Diagnosis, staging and treatment of patients with non-small cell lung cancer for the surgeon","volume":"71","author":"Bryant","year":"2009","journal-title":"Indian J Surg"},{"key":"B19","doi-asserted-by":"publisher","first-page":"265","DOI":"10.1002\/(sici)1097-0142(19990715)86:2%3C265::aid-cncr10%3E3.0.co;2-b","article-title":"A controlled study of postoperative radiotherapy for patients with completely resected nonsmall cell lung carcinoma. Groupe d'Etude et de Traitement des Cancers Bronchiques","volume":"86","author":"Dautzenberg","year":"1999","journal-title":"Cancer"},{"key":"B20","doi-asserted-by":"publisher","first-page":"525","DOI":"10.1016\/0360-3016(93)90375-6","article-title":"Postoperative radiotherapy after pneumonectomy: impact of modern treatment facilities","volume":"27","author":"Phlips","year":"1993","journal-title":"Int J Radiat Oncol Biol Phys"},{"key":"B21","doi-asserted-by":"publisher","first-page":"419","DOI":"10.1093\/jnci\/dji067","article-title":"Risk of cardiac death after adjuvant radiotherapy for breast cancer","volume":"97","author":"Giordano","year":"2005","journal-title":"J Natl Cancer Inst"},{"key":"B22","doi-asserted-by":"publisher","first-page":"3941","DOI":"10.7150\/jca.28680","article-title":"The role of postoperative radiotherapy for completely resected pIIIA-N2 non-small cell lung cancer patients with different clinicopathological features: a systemic review and meta-analysis","volume":"10","author":"Liu","year":"2019","journal-title":"J Cancer"},{"key":"B23","doi-asserted-by":"publisher","first-page":"2820","DOI":"10.1002\/cam4.2937","article-title":"Postoperative intensity-modulated radiation therapy reduces local recurrence and improves overall survival in III-N2 non-small-cell lung cancer: a single-center, retrospective study","volume":"9","author":"Wei","year":"2020","journal-title":"Cancer Med"},{"key":"B24","doi-asserted-by":"publisher","first-page":"379","DOI":"10.1002\/jso.25308","article-title":"The lymph node status and histologic subtypes influenced the effect of postoperative radiotherapy on patients with N2 positive IIIA non-small cell lung cancer","volume":"119","author":"Yuan","year":"2019","journal-title":"J Surg Oncol"},{"key":"B25","doi-asserted-by":"publisher","first-page":"940","DOI":"10.1097\/JTO.0b013e318292c53e","article-title":"Lymph node ratio may predict the benefit of postoperative radiotherapy in non-small-cell lung cancer","volume":"8","author":"Urban","year":"2013","journal-title":"J Thorac Oncol"},{"key":"B26","doi-asserted-by":"publisher","first-page":"741","DOI":"10.1007\/s00408-019-00284-7","article-title":"Postoperative radiotherapy for resected stage IIIA-N2 non-small-cell lung cancer: a population-based time-trend study","volume":"197","author":"Zeng","year":"2019","journal-title":"Lung"},{"key":"B27","doi-asserted-by":"publisher","first-page":"584","DOI":"10.1038\/s41598-017-00619-5","article-title":"Prognostic and predictive effects of positive lymph node number or ratio in NSCLC","volume":"7","author":"Ding","year":"2017","journal-title":"Sci Rep"},{"key":"B28","doi-asserted-by":"publisher","first-page":"1565","DOI":"10.1016\/j.jtho.2016.05.004","article-title":"A proposal for combination of lymph node ratio and anatomic location of involved lymph nodes for nodal classification in non-small cell lung cancer","volume":"11","author":"Ding","year":"2016","journal-title":"J Thorac Oncol"},{"key":"B29","doi-asserted-by":"publisher","first-page":"565","DOI":"10.1055\/a-1008-9598","article-title":"A comparison of the currently used nodal stage classification with the number of metastatic lymph nodes and the number of metastatic lymph node stations for non-small cell lung cancer; which of these is the best prognostic factor?","volume":"145","author":"Citak","year":"2020","journal-title":"Zentralbl Chir"},{"key":"B30","doi-asserted-by":"publisher","first-page":"211","DOI":"10.1016\/j.athoracsur.2007.08.020","article-title":"Number of metastatic lymph nodes in resected non-small cell lung cancer predicts patient survival","volume":"85","author":"Lee","year":"2008","journal-title":"Ann Thorac Surg"},{"key":"B31","doi-asserted-by":"publisher","first-page":"666","DOI":"10.1016\/j.athoracsur.2017.04.063","article-title":"Subcarinal lymph node importance revisited","volume":"105","author":"Riquet","year":"2018","journal-title":"Ann Thorac Surg"}],"container-title":["Frontiers in Surgery"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fsurg.2024.1506854\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,2,4]],"date-time":"2025-02-04T06:33:43Z","timestamp":1738650823000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fsurg.2024.1506854\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,2,4]]},"references-count":31,"alternative-id":["10.3389\/fsurg.2024.1506854"],"URL":"https:\/\/doi.org\/10.3389\/fsurg.2024.1506854","relation":{},"ISSN":["2296-875X"],"issn-type":[{"value":"2296-875X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,2,4]]},"article-number":"1506854"}}