Ⅳ期NSCLC原发肿瘤三维放射治疗失败模式分析  

The patterns of failure with three-dimensional radiation therapy for primary tumors of stageⅣNSCLC

作　　者：吴新宇 苏胜发 欧阳伟炜 李青松 马筑 杨文刚 陈霞霞 耿一超 卢冰 Xinyu Wu;Shengfa Su;Weiwei Ouyang;Qingsong Li;Zhu Ma;Wengang Yang;Xiaxia Chen;Yichao Geng;Bing Lu(Department of Oncology,School of Clinical Medicine,Guizhou Medical University/Department of Oncology,Affiliated Hospital of Guizhou Medical University/Department of Oncology,Affiliated Cancer Hospital of Guizhou Medical University,Guizhou 550004,China)

机构地区：[1]贵州医科大学临床医学院肿瘤学教研室/贵州医科大学附属医院肿瘤科/贵州医科大学附属肿瘤医院肿瘤科,贵州550004

出　　处：《中华放射肿瘤学杂志》2022年第8期691-697,共7页Chinese Journal of Radiation Oncology

基　　金：贵州省科技计划支撑项目(黔科合支撑(2019)2795)。

摘　　要：目的探讨Ⅳ期NSCLC原发肿瘤三维放疗联合药物一线治疗的失败模式特点及放疗相关因素的影响。方法选择2003年3月至2020年7月708例初诊Ⅳ期NSCLC患者,χ2检验失败模式单因素分析;Kaplan-Meier法并log-rank检验、Cox回归模型多因素生存分析。结果708例首次失败发生率71.2%,≤6个月、>6~12个月、>12~24个月、>24个月的治疗失败发生率分别为22.7%、28.8%、13.3%、6.4%,中位生存期分别为7.2、13.4、22.2、37.6个月,差异有统计学意义(χ2=226.013,P<0.001)。复发失败发生率为21.3%,寡转移和非寡转移的复发失败发生率差异无统计学意义。转移失败发生率为66.3%,从高到低依次为脑>骨>肺>胸膜腔>肝>远处淋巴结>肾上腺>其他部位,约1/2病例发生新增转移器官,约1/3病例发生原转移器官进展。转移状态、治疗失败发生时间、病理类型、性别、综合治疗强度是预后的独立影响因素。结论Ⅳ期NSCLC原发肿瘤放疗的失败模式与一线药物治疗不同,局部失败显著降低,转移失败为主,脑转移发生率最高,治疗失败发生时间越晚,OS期越长。寡转移、女性、非鳞癌、治疗失败发生时间晚、4~6个周期化疗同期放疗剂量≥63 Gy是延长生存的独立预后因子。Objective To explore the characteristics of failure patterns of three-dimensional radiotherapy combined with first-line drug therapy for primary tumors of stageⅣnon-small cell lung cancer(NSCLC)and investigate the influence of radiotherapy-related factors.Methods 708 patients newly-diagnosed with stageⅣNSCLC from March 2003 to July 2020 were selected.Chi-square test was used for univariate analysis of failure patterns.Kaplan-Meier method,Log-rank test and Cox regression model were employed for multivariate analysis.Results The incidence of first-line treatment failure in 708 cases was 71.2%,and the incidence of treatment failure was 22.7%,28.8%,13.3%,and 6.4%for≤6 months,>6-12 months,>12-24 months,and>24 months,respectively,and the median survival time was 7.2,13.4,22.2,and 37.6 months,which was significantly different(χ2=226.013,P<0.001).The incidence of recurrence failure(RF)was 21.3%.There was no significant difference in the incidence of RF between oligometastasis(OM)and non-oligometastasis(NOM).The incidence of DF was 66.3%and the order of incidence was brain>bone>lung>pleural cavity>liver>distant lymph nodes>adrenal gland>other sites,occurring in approximately 1/2 of AM and 1/3 of PSM cases.Metastatic status,time to treatment failure,pathological type,gender,combined treatment intensity were the independent influencing factors for predicting prognosis.Conclusions The failure pattern of radiotherapy for primary tumors of stageⅣNSCLC is different from that of first-line drug therapy,with significantly lower local failure and predominantly metastatic failure.The incidence of brain metastasis is the highest.The later time to treatment failure,the longer the overall survival(OS).OM,female,non-squamous cell carcinoma,late treatment failure,4-6 cycles of chemotherapy over the same period≥63 Gy are the independent prognostic factors for prolonging survival.

关 键 词：癌 非小细胞肺 Ⅳ期 放射疗法 原发肿瘤 失败模式 生存 

分 类 号：R730.55[医药卫生—肿瘤]