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  

Prognostic analysis of chemotherapy with concurrent three-dimensional radiotherapy for non-oligometastatic Stage Ⅳ NSCLC

作　　者：苏胜发[1,2] 胡银祥[1,2] 欧阳伟炜[1,2] 马筑[1,2] 李青松[1,2] 陈娟[1,2] 张婧[1,2] 何明媛[1,2] 栗蕙芹[1,2] 何志旭[3] 卢冰[1,2] 

机构地区：[1]贵州医科大学附属医院.贵州省肿瘤医院胸部肿瘤科,贵州贵阳550004 [2]贵州医科大学肿瘤学教研室,贵州贵阳550004 [3]贵州医科大学组织工程及干细胞研究中心,贵州贵阳550004

出　　处：《中华肿瘤防治杂志》2017年第5期322-327,共6页Chinese Journal of Cancer Prevention and Treatment

基　　金：贵州省应用基础研究计划重大专项[黔科合J重大字(2015)2003];贵州省教育厅创新群体重大研究项目[黔教合KY字(2016)032];贵州地区常见疾病的临床研究[黔科合SY字(2014)3021]

摘　　要：目的非寡转移Ⅳ期非小细胞肺癌(non-small cell lung cancer,NSCLC)患者能否从原发肿瘤放疗中获益尚不明确,本研究旨在探讨非寡转移Ⅳ期NSCLC患者化疗同期胸部三维适形放疗(3-dimensional conformal radiation therapy,3DCRT)的疗效及预后影响因素。方法选取2003-01-23-2012-05-13贵州省肿瘤医院404例患者参加两项前瞻性临床研究。入组标准:(1)初诊的且经组织病理学或细胞学确诊为NSCLC;(2)年龄18~80岁;(3)KPS评分≥70;(4)接受≥2个周期化疗且整个病程中未接受分子靶向治疗;(5)胸部原发肿瘤接受3DCRT或调强放疗(intensity modulated radiation therapy,IMRT);(6)胸部原发肿瘤接受放疗剂量≥36Gy。寡转移定义为转移病灶<5个,非寡转移定义为转移病灶≥5个。主要采用以铂类为基础的两药联合化疗。Kaplan-Meier法计算生存率,Log-rank法组间比较及单因素预后分析,Cox模型行多因素预后分析。结果符合入组标准的274例患者为研究对象,其中183例为非寡转移患者。中位生存时间为13.0个月(95%CI为11.9~14.1),1、2和3年总生存率(overall survival,OS)分别为50.7%、15.8%和9.1%;原发肿瘤放疗剂量≥63Gy的1、2和3年OS率为55.3%、22.7%和17.0%,<63Gy的1、2和3年OS率为46.5%、9.3%和2.5%,χ~2=11.497,P<0.001;寡转移患者的1、2和3年OS率分别为59.3%、22.0%和15.2%,非寡转移患者的1、2和3年OS率分别为46.4%、12.7%和6.0%,χ~2=5.741,P=0.017。寡转移(χ~2=7.571、P=0.006)和非寡转移(χ~2=8.242、P=0.004)患者分别进行分析,原发肿瘤放疗剂量≥63Gy仍是影响总生存的因素。非寡转移患者多因素分析显示,原发肿瘤放疗剂量、原发肿瘤体积、化疗疗效达及治疗后KPS是影响总生存的独立因素。亚组分析显示,化疗有效(完全缓解和部分缓解)的非寡转移患者,原发肿瘤放疗剂量≥63Gy是影响生存的因素(χ~2=4.419,P=0.036);化疗有效和无效的非寡转移患者,原发肿瘤放疗剂量≥63Gy与<63Gy的总�OBJECTIVE The role of radiation therapy in addition to chemotherapy has not been well established in non-oligometastatic Stage IV non-small cell lung cancer （NSCLC）. We aimed to investigate overall survival （OS） of non-oligometastatic NSCLC treated with chemotherapy with concurrent radiation to the primary tumor. METHODS From January 23, 2003 to May 13, 2012. Totally 404 patients were enrolled in two prospective studies. Totally, 274 eligible patients were screened from these two prospective studies. Main eligible criteria were as follows： （1） histologically or cytology confirmed NSCLC; （2） age 18-80 years; （3） a Karnofsky Performance Status （KPS） score ≥70; （4） received at least two chemotherapy cycles, and did not receive targeted therapy or immunotherapy during lifetime, （5） using modern radiation technique （3-dimensional conformal radiation therapy [3DCRT] or intensity modulated radiation therapy [IM- RT]）; （6） a thoracic radiation dose of at least 36 Gy. Oligometastatic and non-oligometastatic NSCLC were defined as having 〈 5 and ≥5 metastatic lesions, respectively. Prognostic factors for OS were identified using univariate and multivariate analysis. RESULTS Totally 274 eligible patients were included in this study, 183 had non-oligometastatic disease. The median OS time for all patients was 13.0 months （95% CI： 11.9-14.1）, and the OS rates were 50.7% at 1 year, 15.8% at 2 years, and 9.1% at 3 years. OS rates for patients who had received ≥63 Gy thoracic radiation therapy were 55.3% at 1 year, 22.7% at 2 years, and 17.0% at 3 years. Corresponding rates for those who received ~63 Gy were 46.5%, 9.3%, and 2.5% （χ^2= 11. 497, P〈0. 001）. Comparison of OS in patients with oligometastatic disease versus those with non- oligometastatic disease, the 1-, 2-, and 3-year OS rates were 59. 3%, 22.0% and 15.2% vs 46.4%, 12.7% and 6.0% （χ^2=5. 741, P=0. 017）. When all patients were subdivided into patients with oligometastase （χ^2= 7. 571 ,P= 0. 006）

关 键 词：癌 非小细胞肺/同期化放疗法 放射疗法 三维 Ⅳ期 非寡转移 

分 类 号：R734.2[医药卫生—肿瘤]