Long-term survival patterns and prognostic stratification in patients with unresectable locally advanced squamous cell lung cancer receiving definitive chemoradiotherapy: a 14-year single-center real-world cohort.
- 1Department of Radiation Oncology, The Fourth Hospital of Hebei Medical University & Hebei Clinical Research Center for Radiation Oncology, Shijiazhuang, China.
Abstract
Real-world data with more than 10 years of follow-up among Chinese patients with unresectable locally advanced squamous cell lung cancer (SqCLC) treated with definitive chemoradiotherapy are scarce. This single-center cohort with complete 14-year longitudinal surveillance was constructed to map long-term survival kinetics, screen independent prognostic markers, and depict full disease trajectories, so as to facilitate stratified surveillance and personalized therapeutic management. This retrospective single-center real-world cohort enrolled 260 stage IIIA-IIIC unresectable SqCLC patients receiving definitive chemoradiotherapy between 2012-2019. Kaplan-Meier curves were used to estimate overall survival (OS), first progression-free survival (PFS1), and post-salvage second progression-free survival (PFS2); the log-rank test was applied for inter-group comparison. Multivariable Cox proportional-hazards regression (enter method) was utilized to screen independent prognostic factors, and a clinically-oriented 12-month PFS1 cutoff was used for risk stratification. With maximum follow-up exceeding 14 years (data cut-off June 1, 2026), the 10-year OS rate was 35.0%. The survival curve exhibited a distinct three-phase trajectory: a high-risk phase during the first 3 years accounting for approximately half of all events, a decelerating decline from year 3 to 10, and a stable plateau beyond 10 years, with OS rates at 10 and 14 years both approximating 35%. Multivariable analysis identified age <65 years, peripherally located tumors, absence of radiation pneumonitis, objective response to first-line therapy, and PFS1 ≥12 months as independent protective factors for OS, among which PFS1 ≥12 months yielded the strongest effect [hazard ratio (HR) =2.70, P<0.001]. First disease progression occurred in 86.0% of patients, of whom 32.0% presented with oligometastatic lesions (defined as ≤5 metastatic lesions confined to limited anatomic sites without widespread disseminated disease); those receiving active local salvage therapy achieved a 14-year PFS2 rate of 48.0%. An interval of ≤3 months from diagnosis to radiotherapy initiation was associated with a significantly higher objective response rate (ORR) compared with >3 months (73.0% vs. 57.0%, P<0.05). A 10-year survival rate of 35% is achievable in patients with locally advanced unresectable SqCLC after definitive chemoradiotherapy, with substantially reduced risks of recurrence and all-cause mortality beyond the 10-year landmark. A PFS1 ≥12 months serves as a simple and robust prognostic biomarker for long-term survival, and active local salvage of oligometastatic lesions enables durable disease control. Surveillance schedules and consolidation strategies may be tailored according to patients' progression-free status at 12 months.
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BibTeX
@article{jia2026longterm,
title = {{Long-term survival patterns and prognostic stratification in patients with unresectable locally advanced squamous cell lung cancer receiving definitive chemoradiotherapy: a 14-year single-center real-world cohort.}},
author = {Zhongfei Jia and Jingchen Huo and Jie Yang},
journal = {Journal of thoracic disease},
year = {2026},
month = sep,
doi = {10.21037/jtd-2026-2234},
url = {https://europepmc.org/article/MED/42996892},
note = {CC BY-NC-ND},
}
RIS
TY - JOUR
TI - Long-term survival patterns and prognostic stratification in patients with unresectable locally advanced squamous cell lung cancer receiving definitive chemoradiotherapy: a 14-year single-center real-world cohort.
AU - Zhongfei Jia
AU - Jingchen Huo
AU - Jie Yang
PY - 2026
DA - 2026/09/30
JO - Journal of thoracic disease
DO - 10.21037/jtd-2026-2234
UR - https://europepmc.org/article/MED/42996892
AB - Real-world data with more than 10 years of follow-up among Chinese patients with unresectable locally advanced squamous cell lung cancer (SqCLC) treated with definitive chemoradiotherapy are scarce. This single-center cohort with complete 14-year longitudinal surveillance was constructed to map long-term survival kinetics, screen independent prognostic markers, and depict full disease trajectories, so as to facilitate stratified surveillance and personalized therapeutic management. This retrospective single-center real-world cohort enrolled 260 stage IIIA-IIIC unresectable SqCLC patients receiving definitive chemoradiotherapy between 2012-2019. Kaplan-Meier curves were used to estimate overall survival (OS), first progression-free survival (PFS1), and post-salvage second progression-free survival (PFS2); the log-rank test was applied for inter-group comparison. Multivariable Cox proportional-hazards regression (enter method) was utilized to screen independent prognostic factors, and a clinically-oriented 12-month PFS1 cutoff was used for risk stratification. With maximum follow-up exceeding 14 years (data cut-off June 1, 2026), the 10-year OS rate was 35.0%. The survival curve exhibited a distinct three-phase trajectory: a high-risk phase during the first 3 years accounting for approximately half of all events, a decelerating decline from year 3 to 10, and a stable plateau beyond 10 years, with OS rates at 10 and 14 years both approximating 35%. Multivariable analysis identified age <65 years, peripherally located tumors, absence of radiation pneumonitis, objective response to first-line therapy, and PFS1 ≥12 months as independent protective factors for OS, among which PFS1 ≥12 months yielded the strongest effect [hazard ratio (HR) =2.70, P<0.001]. First disease progression occurred in 86.0% of patients, of whom 32.0% presented with oligometastatic lesions (defined as ≤5 metastatic lesions confined to limited anatomic sites without widespread disseminated disease); those receiving active local salvage therapy achieved a 14-year PFS2 rate of 48.0%. An interval of ≤3 months from diagnosis to radiotherapy initiation was associated with a significantly higher objective response rate (ORR) compared with >3 months (73.0% vs. 57.0%, P<0.05). A 10-year survival rate of 35% is achievable in patients with locally advanced unresectable SqCLC after definitive chemoradiotherapy, with substantially reduced risks of recurrence and all-cause mortality beyond the 10-year landmark. A PFS1 ≥12 months serves as a simple and robust prognostic biomarker for long-term survival, and active local salvage of oligometastatic lesions enables durable disease control. Surveillance schedules and consolidation strategies may be tailored according to patients' progression-free status at 12 months.
SN - 2072-1439
SN - 2077-6624
ER -