放疗相关因素对伴恶性胸腔积液非小细胞肺癌生存的影响

doi:10.3760/cma.j.cn113030-20201026-00517

摘要
图/表
参考文献(33)
相关文章 (15)
点击分布统计
下载分布统计

全文: PDF (0 KB) HTML (1 KB)
输出: BibTeX | EndNote (RIS) 背景资料

摘要目的回顾分析伴恶性胸腔积液(MPE)的非小细胞肺癌(NSCLC)原发灶放疗相关因素对生存影响。方法 2007—2019年间经病理学证实、初治的伴MPE的NSCLC共256例,其中117例纳入分析。按放疗剂量<63Gy与≥63Gy分为2个组,采用倾向性评分匹配法均衡组间混杂因素(卡钳值=0.1)。Kaplan-Meier法计算生存并log-rank单因素分析,Cox模型多因素分析放疗相关因素对总生存(OS)影响。结果原发灶放疗可延长OS(P<0.001),且随剂量36.0~44.1Gy、45.0~62.1Gy、63.0~71.1Gy提高OS延长(P<0.001),中位生存期分别为5、13、18个月。匹配前单因素分析显示原发灶剂量≥63Gy、大体肿瘤体积<157.7cm³、引流区淋巴结转移≤5站的OS延长(均P<0.05),T4N3期较其他期患者OS降低(P=0.018);匹配后单因素分析显示原发灶剂量≥63Gy的OS仍延长(P=0.013),≤5站引流区淋巴结转移OS呈延长趋势(P=0.098)。匹配前多因素分析显示原发灶放疗剂量≥63Gy是延长生存的独立预后因素(HR=0.566,95%CI为0.368~0.871,P=0.010),GTV<157.7cm³有延长OS趋势(HR=0.679,95%CI为0.450~1.024,P=0.065);匹配后多因素分析显示原发灶放疗剂量≥63Gy仍是延长生存的独立预后因素(HR=0.547,95%CI为0.333~0.899,P=0.017)。3级急性放射性食管炎和放射性肺炎分别为9.4%、5.1%,无≥4级不良反应。结论 MPE-NSCLC在胸腔积液可控的前提下,原发灶放疗剂量对延长OS可能起关键作用。

	服务

	把本文推荐给朋友
	加入我的书架
	加入引用管理器
	E-mail Alert
	RSS
	作者相关文章
	李青松
	欧阳伟炜
	苏胜发
	马筑
	耿一超
	杨文刚
	胡银祥
	栗蕙芹
	李晓阳
	陈霞霞
	卢冰

关键词 ：恶性胸腔积液, 肺肿瘤/放射疗法, 放射疗法,调强, 预后

Abstract：Objective To analyze the radiotherapy-related factors affecting the survival of non-small cell lung cancer (NSCLC) patients complicated with malignant pleural effusion (MPE)(MPE-NSCLC). Methods From 2007 to 2019, 256 patients pathologically diagnosed with MPE-NSCLC received primary treatment. Among them, 117 cases were enrolled in this study. All patients were divided into two groups according to the radiation dose (<63Gy and≥63Gy). Propensity score matching (PSM) was performed to further adjust the confounding factors (Calipers value=0.1). The impact of radiotherapy-related factors on the overall survival (OS) was analyzed by Kaplan—Meier method, log-rank test and Cox’s regression model. Results Primary tumor radiotherapy significantly prolonged the OS (P<0.001). The radiation dose escalation (36.0-44.1Gy, 45.0-62.1Gy, 63.0-71.1Gy) of primary tumor significantly prolonged the OS (P<0.001). The corresponding median OS were 5, 13 and 18 months, respectively. Before the PSM,univariate analysis suggested that radiation dose ≥63Gy, gross tumor volume (GTV)<157.7cm³ and stations of metastatic lymph node (S-mlN)≤5 were significantly associated with better OS (all P<0.05) and T4N3 was significantly associated with worse OS (P=0.018). After the PSM,univariate analysis indicated that radiation dose ≥63Gy was significantly associated with better OS (P=0.013) and S-mlN ≤5had a tendency to prolong the OS (P=0.098). Prior to the PSM, multivariate analysis showed that radiation dose ≥63Gy was an independent favorable factor of OS (HR=0.566,95%CI 0.368-0.871,P=0.010) and GTV<157.7cm³had a tendency to prolong the OS (HR=0.679,95%CI 0.450-1.024,P=0.065). After the PSM, multivariate analysis revealed that radiation dose ≥63Gy was still an independent favorable factor of OS (HR=0.547,95%CI 0.333~0.899,P=0.017). No ≥grade 4 radiation toxicity occurred. The incidence rates of grade 3 radiation esophagitis and pneumonitis were 9.4% and 5.1%, respectively. Conclusion For MPE-NSCLC, radiotherapy dose of primary tumor may play a key role in improving OS on the basis of controllable MPE.

Key words： Malignant pleural effusion Lung neoplasm/radiotherapy Radiotherapy,intensity-modulated Prognosis

收稿日期: 2020-10-26

通讯作者: 卢冰, Email:lbgymaaaa@163.com

引用本文:

李青松,欧阳伟炜,苏胜发等. 放疗相关因素对伴恶性胸腔积液非小细胞肺癌生存的影响[J]. 中华放射肿瘤学杂志, 2021, 30(2): 120-126.

Li Qingsong,Ouyang Weiwei,Su Shengfa et al. Impact of radiotherapy-related factors on survival in non-small cell lung cancer complicated with malignant pleural effusion based on propensity score matching[J]. Chinese Journal of Radiation Oncology, 2021, 30(2): 120-126.

链接本文:

http://journal12.magtechjournal.com/Jweb_fszlx/CN/10.3760/cma.j.cn113030-20201026-00517 或 http://journal12.magtechjournal.com/Jweb_fszlx/CN/Y2021/V30/I2/120

[1] Siegel RL, Miller KD, Jemal A. Cancer statistics, 2019[J]. CA Cancer J Clin, 2019, 69(1):7-34. DOI:10.3322/caac.21551.
[2] 苏胜发,胡银祥,欧阳伟炜,等. 非寡转移Ⅳ期非小细胞肺癌化疗同期胸部三维放疗预后分析[J]. 中华肿瘤防治杂志, 2017, 24(5):322-327. DOI:10.16073/j.cnki.cjcpt.2017.05.008.
Su SF, Hu YX, Ouyang WW, et al. Prognostic analysis of chemotherapy with concurrent three-dimensional radiotherapy for non-oligometastatic stage Ⅳ NSCLC[J]. Chin J Cancer Prev Treat, 2017, 24(5):322-327. DOI:10.16073/j.cnki.cjcpt.2017.05.008.
[3] Su S, Li T, Lu B, et al. Three-dimensional radiation therapy to the primary tumor with concurrent chemotherapy in patients with stage Ⅳ non-small cell lung cancer:results of a multicenter phase 2 study from PPRA-RTOG, China[J]. Int J Radiat Oncol Biol Phys, 2015, 93(4):769-777. DOI:10.1016/j.ijrobp.2015.08.012.
[4] Koshy M, Malik R, Mahmood U, et al. Comparative effectiveness of aggressive thoracic radiation therapy and concurrent chemoradiation therapy in metastatic lung cancer[J]. Pract Radiat Oncol, 2015, 5(6):374-382. DOI:10.1016/j.prro.2015.07.009.
[5] Zheng L, Wang Y, Xu Z, et al. Concurrent EGFR-TKI and thoracic radiotherapy as first-line treatment for stage ⅠV non-small cell lung cancer harboring EGFR active mutations[J]. Oncologist, 2019, 24(8):1031-1037. DOI:10.1634/theoncologist.2019-0285.
[6] Hanna GG, Illidge T. Radiotherapy and immunotherapy combinations in non-small cell lung cancer:a promising future[J]. Clin Oncol (R Coll Radiol), 2016, 28(11):726-731. DOI:10.1016/j.clon.2016.07.014.
[7] 韦天宇,马筑,陈霞霞,等. 伴恶性胸腔积液Ⅳ期NSCLC原发灶三维放疗的临床分析[J]. 中华放射肿瘤学杂志, 2020, 29(7):523-528. DOI:10.3760/cma.j.cn113030-20190623-00239.
Wei TY, Ma Z, Chen XX, et al. Clinical outcome of radiotherapy for primary tumors in stage ⅠV non-small cell lung cancer complicated with malignant pleural effusion[J]. Chin J Radiat Oncol, 2020, 29(7):523-528. DOI:10.3760/cma.j.cn113030-20190623-00239.
[8] Su S, Hu Y, Ouyang W, et al. Might radiation therapy in addition to chemotherapy improve overall survival of patients with non-oligometastatic stage ⅠV non-small cell lung cancer:secondary analysis of two prospective studies[J]. BMC Cancer, 2016, 16(1):908. DOI:10.1186/s12885-016-2952-3.
[9] Arrieta O, Barrón F, Maldonado F, et al. Radical consolidative treatment provides a clinical benefit and long-term survival in patients with synchronous oligometastatic non-small cell lung cancer:a phase Ⅱ study[J]. Lung Cancer, 2019, 130(1):67-75. DOI:10.1016/j.lungcan.2019.02.006.
[10] Griffioen GH, Toguri D, Dahele M, et al. Radical treatment of synchronous oligometastatic non-small cell lung carcinoma (NSCLC):patient outcomes and prognostic factors[J]. Lung Cancer, 2013, 82(1):95-102. DOI:10.1016/j.lungcan.2013.07.023.
[11] Porcel JM, Gasol A, Bielsa S, et al. Clinical features and survival of lung cancer patients with pleural effusions[J]. Respirology, 2015, 20(4):654-659. DOI:10.1111/resp.12496.
[12] Morgensztern D, Waqar S, Subramanian J, et al. Prognostic impact of malignant pleural effusion at presentation in patients with metastatic non-small-cell lung cancer[J]. J Thorac Oncol, 2012, 7(10):1485-1489. DOI:10.1097/JTO.0b013e318267223a.
[13] Hak CC, Sivakumar P, Ahmed L. Safety of indwelling pleural catheter use in patients undergoing chemotherapy:a five-year retrospective evaluation[J]. BMC Pulm Med, 2016, 16(1):41. DOI:10.1186/s12890-016-0203-7.
[14] Kasapoglu US, ArncSA, Gungor S, et al. Prognostic factors affecting survival in non-small cell lung carcinoma patients with malignant pleural effusions[J]. Clin Respir J, 2016, 10(6):791-799. DOI:10.1111/crj.12292.
[15] Wang J, Ji Z, Wang X, et al. Radical thoracic radiotherapy may provide favorable outcomes for stage ⅠV non-small cell lung cancer[J]. Thorac Cancer, 2016, 7(2):182-189. DOI:10.1111/1759-7714.12305.
[16] 张波,卢冰,苏胜发,等. Ⅳ期非小细胞肺癌化疗同期胸部三维放疗的前瞻性临床研究(四)——近期疗效对生存的影响[J]. 中华放射肿瘤学杂志,2012, 21(1):29-34. DOI:10.3760/cma.j.issn.1004-4221.2012.01.010.
Zhang B, Lu B, Su SF, et al. A prospective study on concurrent chemotherapy and thoracic three-dimensional radiotherapy for stage ⅠV non-small cell lung cancer (4)-The impact of response on survival[J]. Chin J Radiat Oncol, 2012, 21(1):29-34. DOI:10.3760/cma.j.issn.1004-4221.2012.01. 010.
[17] Yang CJ, Wang H, Kumar A, et al. Impact of timing of lobectomy on survival for clinical stage Ⅰ a lung squamous cell carcinoma[J]. Chest, 2017, 152(6):1239-1250. DOI:10.1016/j.chest.2017.07.032.
[18] Ost DE, Jim YSC, Tanoue LT, et al. Clinical and organizational factors in the initial evaluation of patients with lung cancer:diagnosis and management of lung cancer, 3^rd ed:American College of Chest Physicians evidence-based clinical practice guidelines[J]. Chest, 2013, 143(5 suppl):e121s-e141s. DOI:10.1378/chest.12-2352.
[19] Gomez DR, Liao KP, Swisher SG, et al. Time to treatment as a quality metric in lung cancer:staging studies, time to treatment, and patient survival[J]. Radiother Oncol, 2015, 115(2):257-263. DOI:10.1016/j.radonc.2015.04. 010.
[20] Bryant AS, Cerfolio RJ. Impact of race on outcomes of patients with non-small cell lung cancer[J]. J Thorac Oncol, 2008, 3(7):711-715. DOI:10.1097/JTO.0b013e31817 c60c7.
[21] Curran WJ, Paulus R, Langer CJ, et al. Sequential vs. concurrent chemoradiation for stage Ⅲ non-small cell lung cancer:randomized phase Ⅲ trial RTOG 9410[J]. J Natl Cancer Inst, 2011, 103(19):1452-1460. DOI:10.1093/jnci/djr325.
[22] Liang HY, Zhou H, Li XL, et al. Chemo-radiotherapy for advanced non-small cell lung cancer:concurrent or sequential? It′s no longer the question:a systematic review[J]. Int J Cancer, 2010, 127(3):718-728. DOI:10.1002/ijc.25087.
[23] Lopez GJL, Gomez D, Zhuang Y, et al. Prognostic impact of radiation therapy to the primary tumor in patients with non-small cell lung cancer and oligometastasis at diagnosis[J]. Int J Radiat Oncol Biol Phys, 2012, 84(1):e61-67. DOI:10.1016/j.ijrobp.2012.02.054.
[24] Parikh RB, Cronin AM, Kozono DE, et al. Definitive primary therapy in patients presenting with oligometastatic non-small cell lung cancer[J]. Int J Radiat Oncol Biol Phys, 2014, 89(4):880-807. DOI:10.1016/j.ijrobp.2014.04. 007.
[25] Li S, Zhu R, Li D, et al. Prognostic factors of oligometastatic non-small cell lung cancer:a meta-analysis[J]. J Thorac Dis, 2018, 10(6):3701-3713. DOI:10.21037/jtd.2018.05.105.
[26] Chin AL, Kumar KA, Guo HH, et al. Prognostic value of pretreatment fdg-pet parameters in high-dose image-guided radiotherapy for oligometastatic non-small-cell lung cancer[J]. Clin Lung Cancer, 2018, 19(5):e581-e588. DOI:10.1016/j.cllc.2018.04.003.
[27] Ashworth A, Rodrigues G, Boldt G, et al. Is there an oligometastatic state in non-small cell lung cancer? A systematic review of the literature[J]. Lung Cancer, 2013, 82(2):197-203. DOI:10.1016/j.lungcan.2013.07.026.
[28] Jabbour SK, Daroui P, Moore D, et al. A novel paradigm in the treatment of oligometastatic non-small cell lung cancer[J]. J Thorac Dis, 2011, 3(1):4-9. DOI:10.3978/j.issn.2072-1439.2010.12.09.
[29] Ouyang WW, Su SF, Hu YX, et al. Radiation dose and survival of patients with stage ⅠV non-small cell lung cancer undergoing concurrent chemotherapy and thoracic three-dimensional radiotherapy:reanalysis of the findings of a single-center prospective study[J]. BMC Cancer, 2014, 14:491. DOI:10.1186/1471-2407-14-491.
[30] Nieder C, Tollali T, Yobuta R, et al. Palliative thoracic radiotherapy for lung cancer:what is the impact of total radiation dose on survival[J]. J Clin Med Res, 2017, 9(6):482-487. DOI:10.14740/jocmr2980w.
[31] Herrera LS, Fernández-Fabrellas E, Juan SG, et al. Cytotoxic natural killer subpopulations as a prognostic factor of malignant pleural effusion[J]. Lung, 2019, 197(1):53-60. DOI:10.1007/s00408-018-0186-7.
[32] 罗兰,欧阳伟炜,苏胜发,等. 原发灶体积对Ⅳ期非小细胞肺癌生存影响——来自多中心Ⅱ期前瞻性临床研究结果再分析[J]. 中华放射肿瘤学杂志, 2019, 28(9):660-664. DOI:10.3760/cma.j.issn.1004-4221.2019.005.
Luo L, Ouyang WW, Su SF, et al. Influence of survival in primary volume for stage ⅠV non-small cell lung cancer on survival-re-analysis of phase Ⅱ multicenter prospective clinical findings[J]. Chin J Radiat Oncol, 2019, 28(9):660-664. DOI:10.3760/cma.j.issn.1004-4221.2019.005.
[33] Citak N, Aksoy Y, IsgörcüÖ,et al. 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[J]. Zentralbl Chir, 2019, 145(6):565-573. DOI:10.1055/a-1008-9598.