Clinical Outcomes and Predictive Factors in NSCLC after Surgery: Findings from the RAC-TAC Study

Purpose Recent trials like LUNG-ART and PORT-C have redefined postoperative radiation therapy (PORT) for pN2 non-small cell lung cancer (NSCLC). To assess the acute and long-term toxicities of contemporary PORT techniques, the Italian Association of Radiotherapy and Oncology Lung Cancer Study Group initiated a multicenter observational study, analyzing clinical factors influencing local control, distant control, and overall survival. Methods Data from 6 Italian centers were reviewed for NSCLC patients undergoing PORT between 2015 and 2020. Acute and late toxicity outcomes were previously reported. This study correlates clinical variables with local recurrence, distant recurrence, and survival outcomes. Results Local recurrence correlated with the number of lymph nodes removed (P = .003) and patient age (P = .006). Distant recurrence was linked to the number of positive lymph nodes (P = .001) and T stage (P = .009). Overall survival was significantly associated with the number of positive nodes (P = .006) and ECOG performance status (P < .001). A risk stratification system categorized patients into low, intermediate, and high-risk groups, with the low-risk group showing significantly better progression-free survival (P < .001), distant control (P = .004), and overall survival (P = .008). Conclusions Distant metastases remain the main recurrence type. The extent of lymph node dissection and the count of positive nodes significantly influence recurrence patterns. These findings support integrating systemic and local therapies to improve outcomes in pN2 NSCLC.