Irradical (R1-2) resection for non-small cell lung cancer (NSCLC) is associated with a dismal prognosis. Adjuvant treatment attempts to improve survival outcomes, but evidence on the optimal strategy is limited. The purpose of this study was to compare overall survival (OS) between different adjuvant treatment strategies in these patients.

Out of 8,528 patients with newly diagnosed NSCLC from 2015-2018, those with an R1-2 resection were identified from the Netherlands Cancer Registry. First, OS was compared between adjuvant treatment groups ‘no therapy’, ‘radiotherapy (RT) only’, ‘chemotherapy only’, and ‘chemo- and radiotherapy (CRT)’ using multinomial propensity score-weighted Cox regression analysis. Second, three 1:1 propensity score-matched sets were created for chemotherapy vs no chemotherapy, RT only vs no therapy, and CRT vs chemotherapy only. Kaplan-Meier and Cox regression analyses for OS were performed in each set.

With a median follow-up of 23 months, 427 patients were selected. In the weighted regression analysis, compared to no adjuvant therapy, chemotherapy and CRT were associated with improved OS (HR 0.41, 95%CI: 0.22-0.76; and HR 0.55, 95%CI: 0.37-0.81, respectively), whereas RT was not (HR 1.04, 95%CI: 0.73-1.50). In the matched sets, OS was improved after chemotherapy (+/- RT) compared to no chemotherapy (HR 0.47, 95%CI: 0.32-0.69). No OS difference was observed between matched groups of RT only vs no adjuvant therapy (HR 1.13, 95%CI: 0.74-1.72), nor for CRT vs chemotherapy only (HR 1.37, 95%CI: 0.70-2.71). Adjuvant chemotherapy, but not radiotherapy, improves survival after an R1-2 resection in stage I-III NSCLC.

非小细胞肺癌 (NSCLC) 的非根治性 (R1-2) 切除术与预后不良有关。辅助治疗试图改善生存结果，但最佳策略的证据有限。本研究的目的是比较这些患者不同辅助治疗策略之间的总生存期 (OS)。

在 2015-2018 年新诊断的 8,528 名 NSCLC 患者中，从荷兰癌症登记处确定了接受 R1-2 切除的患者。首先，使用多项倾向评分加权 Cox 回归分析比较辅助治疗组“无治疗”、“仅放疗 (RT)”、“仅化疗”和“放化疗 (CRT)”的 OS。其次，针对化疗与不化疗、仅放疗与不治疗以及 CRT 与仅化疗创建了三个 1:1 倾向评分匹配组。在每组中进行 OS 的 Kaplan-Meier 和 Cox 回归分析。

中位随访时间为 23 个月，选择了 427 名患者。在加权回归分析中，与无辅助治疗相比，化疗和 CRT 与改善 OS 相关（HR 0.41，95%CI：0.22-0.76；HR 0.55，95%CI：0.37-0.81），而 RT不是（HR 1.04，95%CI：0.73-1.50）。在匹配组中，化疗 (+/- RT) 后的 OS 与未化疗相比有所改善 (HR 0.47, 95%CI: 0.32-0.69)。仅 RT 与无辅助治疗 (HR 1.13, 95%CI: 0.74-1.72) 匹配组之间没有观察到 OS 差异，CRT 与仅化疗 (HR 1.37, 95%CI: 0.70-2.71) 之间也没有观察到 OS 差异。在 I-III 期非小细胞肺癌 R1-2 切除术后，辅助化疗而非放疗可提高生存率。