术后放疗 (PORT) 是非小细胞肺癌 (NSCLC) 患者的治疗策略。然而，一些研究表明，包括肺 ART 三期试验在内，PORT 对总生存期 (OS) 没有改善作用。需要确认 PORT 的作用和高风险群体。从 2004 年到 2015 年的综合肿瘤学研究计划 (SEER) 中选择符合条件的患者。考虑年龄 ≥18 岁、分期为 IIIA-N2 NSCLC、接受 PORT 或未接受 PORT 的患者。进行 Cox 回归分析和多元竞争风险模型。进行倾向得分匹配 (PSM)。使用中国的单中心研究数据进行验证。所有 IIIA-N2 NSCLC 患者中，呼吸系统疾病的死亡率逐年增加，以右肺相关死亡比例最高。在 SEER 数据库中，PORT 在 PSM 后对 OS 有害 (风险比 [HR]，1.088；95% CI，1.088-1.174；P = 0.031)，同样具有引起肺部死亡的趋势 (HR，1.13；95% CI，1.04-1.22；P = 0.005)。接受 PORT 的右肺肿瘤更容易死于肺部疾病 (HR，1.14；95% CI，1.02-1.27；P = 0.018)。在中国的单中心队列中，PORT 与恶化的 OS 显著相关 (HR 1.356；95% CI 1.127-1.632；P ＜ 0.01)，特别是在右侧的患者 (HR 1.365；95% CI 1.062-1.755；P = 0.015)。PORT 是 IIIA-N2 NSCLC 患者的危险因素，特别是具有右侧位置、男性、年龄≥65 岁和晚期肿瘤阶段等特征的患者。这些患者接受 PORT 后更容易死于肺部疾病。版权所有 © 2023 Mo、Chen、Wang、Wu 和 Yu。

Postoperative radiotherapy (PORT) is a therapeutic strategy for patients with non-small cell lung cancer (NSCLC). Nevertheless, some studies suggesting PORT does not improve overall survival (OS) including Lung ART phase III trial. The role of PORT and high-risk groups need to be confirmed.Patients from the Surveillance, Epidemiology, and End Results program (SEER) from 2004 to 2015 were eligible. Aged ≥18 years with stage IIIA-N2 NSCLC, accepted PORT or not were considered for the study. Cox regression analyses and multivariate competing risk model were performed. Propensity score matching (PSM) was conducted. Data from a single-center study in China were used for validation.In all patients with IIIA-N2 NSCLC, death from respiratory illness increased year by year, with right lung-related deaths accounting for the main proportion. In SEER database, PORT was detrimental for OS after PSM (hazard ratio [HR], 1.088; 95% CI, 1.088-1.174; P = 0.031), with a same trend for death from the lungs (HR, 1.13; 95% CI, 1.04-1.22; P = 0.005). Right tumor receiving PORT were prone to death from lung disease(HR, 1.14; 95% CI, 1.02-1.27; P = 0.018). In China single-center cohort, PORT was significantly correlated with deteriorated OS (HR 1.356; 95% CI 1.127-1.632; P <0.01), especially in the right laterality (HR 1.365; 95% CI 1.062-1.755; P = 0.015).PORT was a risk factor for stage IIIA-N2 NSCLC patients, particularly with characters of right laterality, male sex, age ≥65 years, and advanced tumor stage. These patients are more likely to death from lung disease after PORT.Copyright © 2023 Mo, Chen, Wang, Wu and Yu.