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

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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.

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	Articles by authors
	Li Qingsong
	Ouyang Weiwei
	Su Shengfa
	Ma Zhu
	Geng Yichao
	Yang Wengang
	Hu Yinxiang
	Li Huiqin
	Li Xiaoyang
	Chen Xiaxia
	Lu Bing

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

Received: 26 October 2020

Corresponding Authors: Lu Bing, Email:lbgymaaaa@163.com

Cite this article:

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.

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http://journal12.magtechjournal.com/Jweb_fszlx/EN/10.3760/cma.j.cn113030-20201026-00517 OR http://journal12.magtechjournal.com/Jweb_fszlx/EN/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.