Ⅳ期NSCLC化疗同期三维放疗的预后再分析

doi:10.3760/cma.j.issn.1004-4221.2014.06.007

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摘要目的进一步分析Ⅳ期NSCLC化疗同期三维放疗的预后因素。方法对2003—2010年前瞻性入组201例Ⅳ期NSCLC患者重新进行预后评价,包括依据放疗剂量>36 Gy的159例OS的影响因素分析,以及120例PFS的影响因素分析。化疗以铂类为基础的两药联合方案,中位周期数4个。原发肿瘤中位放疗剂量63 Gy。Kaplan-Meier法计算生存率并Logrank检验,Cox模型预后多因素分析时间从最长的3年延长至5年。结果全组201例1、2、3、5年OS及中位生存期分别为40.1%、17.3%、10.2%、5.1%及10个月。近期疗效中CR、PR、SD、PD分别为7.5%、66.0%、19.5%、6.9%,其中位生存期分别为19、13、8、6个月(P=0.000)。化疗4~5周期同期≥63 Gy与<63 Gy患者1、2、3、5年PFS和中位生存期分别为77.4%、36.2%、27.2%、15.9%和20个月与32.6%、21.7%、0%、0%和9个月(P=0.002)。4~5周期化疗、疗后KPS稳定或增加、GTV<175 cm³为OS影响因素(P=0.035、0.000、0.008)。原发肿瘤三维放疗≥63 Gy对PFS的影响接近有统计学意义(P=0.051)。结论 Ⅳ期NSCLC 4~5个周期化疗同期三维放疗≥63 Gy三维放疗使PFS、OS明显延长。

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	欧阳伟炜
	卢冰
	苏胜发
	胡银祥
	马筑
	李青松
	耿一超
	陈霞霞
	杨文刚
	栗蕙芹

关键词 ：癌, 非小细胞肺/化学疗法, 癌, 非小细胞肺/三维放射疗法, 预后

Abstract：Objective To further analyze the prognostic factors in stage IV non-small cell lung cancer (NSCLC) treated by chemotherapy with concurrent three-dimensional radiotherapy. Methds We enrolled 201 patients with stage IV NSCLC in this study from January 2003 to July 2010 and analyzed overall survival (OS) in 159 patients (three-dimensional radiotherapy>36 Gy) and progression-free survival (PFS) in 120 patients. Platinum-based doublets chemotherapy was performed, and the median number of cycles was 4;the median dose to the planning target volume was 63 Gy. Survival rates were calculated by the Kaplan-Meier method and compared by the log-rank test. The time of multivariate prognostic analysis with the Cox model was increased from 3 years to 5 years. Results The 1-, 2-, 3-, and 5-year OS rates were 40.1%, 17.3%, 10.2%, and 5.1%, respectively, and the median survival time was 10 months. The short-term complete response, partial response, stable disease, and progressive disease rates were 7.5%, 66.0%, 19.5%, and 6.9%, respectively, and the median survival times were 19, 13, 8, and 6 months, respectively (P=0.000). The 1-, 2-, 3-, and 5-year PFS rates and median survival times of patients undergoing 4 to 5 cycles of chemotherapy with radiotherapy doses of ≥63 Gy and<63 Gy were 77.4% vs. 32.6%, 36.2% vs. 21.7%, 27.2% vs. 0%, 15.9% vs. 0%, and 20 vs. 9 months, respectively (P=0.002). According to multivariate analysis, 4 to 5 cycles of chemotherapy, stable or increased Karnofsky Performance Scale score after treatment, and gross tumor volume<175 cm³ were independent prognostic factors for a better OS (P=0.035, 0.000, and 0.008, respectively). Radiation dose to the primary tumor≥63 Gy resulted in a better PFS (P=0.051), which was of borderline significance. ConclusionsChemotherapy (4-5 cycles) with concurrent three-dimensional radiotherapy (≥63 Gy) may significantly prolong PFS and OS in patients with stage IV NSCLC.

Key words： Carcinoma,non-small cell lung/chemotherapy Carcinoma,non-small cell lung/three-dimensional radiotherapy Prognosis

收稿日期: 2014-07-21

基金资助:贵州省科技公关项目[SY (2010)3078];贵州省科学技术基金项目[J2010-2186]

通讯作者: 卢冰,Email:lbgymaaaa@sohu.com

引用本文:

欧阳伟炜,卢冰,苏胜发等. Ⅳ期NSCLC化疗同期三维放疗的预后再分析[J]. 中华放射肿瘤学杂志, 2014, 23(6): 485-488.

Ouyang-Wei Wei,Lu Bing,Su Shengfa et al. Prognostic reanalysis of stage IV non-small cell lung cancer treated by chemotherapy with concurrent three-dimensional radiotherapy[J]. Chinese Journal of Radiation Oncology, 2014, 23(6): 485-488.

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http://journal12.magtechjournal.com/Jweb_fszlx/CN/10.3760/cma.j.issn.1004-4221.2014.06.007 或 http://journal12.magtechjournal.com/Jweb_fszlx/CN/Y2014/V23/I6/485

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