147例T_(1-2)N_(0)M_(0)期非小细胞肺癌患者SBRT后失败模式及生存分析  

Analysis of failure patterns and survival after SBRT for 147 cases of T_(1-2)N_(0)M_(0)stage non-small celllungcancer

作　　者：汪琳 王瑞琪 董百强 胡晓[2] 马红莲[2] 王准[2] 赖霄晶[2] 封巍[2] 林晓[2] 蒋友华[5] 王长春[5] 赵强[5] 江海涛[6] 李浦[7] 杜向慧[2] 陈明[3,4] 陈奇勋[5] 徐裕金[2] Wang Lin;Wang Ruiqi;Dong Baiqiang;Hu Xiao;Ma Honglian;Wang Zhun;Lai Xiaojing;Feng Wei;Lin Xiao;Jiang Youhua;Wang Changchun;Zhao Qiang;Jiang Haitao;Li Pu;Du Xianghui;Chen Ming;Chen Qixun;Xu Yujin(School of Medicine,Shaoxing University,Shaoxing 312000,China;Department of Thoracic Radiotherapy,Zhejiang Cancer Hospital,Hangzhou Institute of Medicine(HIM),Chinese Academy of Sciences,Hangzhou 310022,China;State Key Laboratory of Oncology in South China,Sun Yat-sen University Cancer Center,Guangzhou 510060,China;United Laboratory of Frontier Radiotherapy Technology of Sun Yat-sen University&Chinese Academy of Sciences Ion Medical Technology Co.,Ltd,Guangzhou 510060,China;Department of Thoracic Surgery,Zhejiang Cancer Hospital,Hangzhou Institute of Medicine(HIM),Chinese Academy of Sciences,Hangzhou 310022,China;Department of Radiology,Zhejiang Cancer Hospital,Hangzhou Institute of Medicine(HIM),Chinese Academy of Sciences,Hangzhou 310022,China;Department of Radiation Physics,Zhejiang Cancer Hospital,Hangzhou Institute of Medicine(HIM),Chinese Academy of Sciences,Hangzhou 310022,China)

机构地区：[1]绍兴文理学院医学院,绍兴312000 [2]浙江省肿瘤医院胸部放疗科,中国科学院杭州医学研究所,杭州310022 [3]中山大学肿瘤防治中心,华南恶性肿瘤防治全国重点实验室,广州510060 [4]中山大学-国科离子放射治疗前沿技术联合实验室,广州510060 [5]浙江省肿瘤医院胸部外科,中国科学院杭州医学研究所,杭州310022 [6]浙江省肿瘤医院放射科,中国科学院杭州医学研究所,杭州310022 [7]浙江省肿瘤医院放射物理科,杭州310022

出　　处：《中华放射肿瘤学杂志》2023年第8期683-688,共6页Chinese Journal of Radiation Oncology

基　　金：浙江省医药卫生科技面上项目(2020KY079);北京希思科领航肿瘤研究基金项目(Y-2019AZMS-0061);北京科创医学发展基金会基金项目(KC2021-JX-0186-63)。

摘　　要：目的分析T_(1-2)N_(0)M_(0)期非小细胞肺癌(NSCLC)患者体部立体定向放疗(SBRT)后的失败模式及生存情况。方法回顾性分析2012年1月至2018年9月在浙江省肿瘤医院接受SBRT的早期NSCLC患者病例。主要观察终点是疾病进展模式, 分为野内复发、区域淋巴结复发及远处转移。采用Kaplan-Meier法生存分析计算总生存(OS)、无进展生存(PFS), log-rank检验进行单因素分析, Cox模型行多因素分析。结果共纳入147例患者, 156个病灶, 中位随访时间为44.0(16.5~95.5)个月。共57例(38.8%)患者发生进展, 其中:复发患者14例(24.5%), 1、3、5年的局部复发率分别为2.0%、10.9%、14.3%;远处转移36例(63.2%), 1、3、5年的远处转移率分别为12.2%、22.4%、28.6%;复发合并远处转移的患者7例(12.3%)。全组患者的3、5、7年OS分别为80.5%、64.2%、49.9%, 中位OS为78.4个月, 3、5、7年的PFS分别为64.8%、49.5%、41.5%, 中位PFS为57.9个月(95%CI为42.3~73.5个月)。单因素及多因素分析均显示生物等效剂量、年龄是影响SBRT疗效的因素(P均<0.05)。结论 T1-2N0M0期非小细胞肺癌患者行SBRT后失败模式主要为远处转移, 应筛选高危人群联合系统治疗以提高疗效。Objective To analyze the failure patterns and survival after stereotactic body radiotherapy(SBRT)in patients with T_(1-2)N_(0)M_(0)non-small cell lung carcinoma(NSCLC).Methods Clinical data of early-stage NSCLC patients who received SBRT at Zhejiang Cancer Hospital from January 2012 to September 2018 were retrospectively analyzed.The primary observed endpoint was the pattern of disease progression,which was divided into intra-field recurrence,regional lymph node recurrence and distant metastasis.Overall survival(os)and progression-free survival(PFS)were calculated by Kaplan-Meier method.Univariate analysis was conducted by log-rank test,and multivariate analysis was performed by Cox's model.Results A total of 147 patients with 156 lesions were included.The median follow-up time was 44.0 months(16.5-95.5 months).A total of 57 patients(38.8%)progressed:14 patients(24.5%)had recurrence with the 1-,3-,and 5-year local recurrence rates of 2.0%,10.9%,and 14.3%,respectively;36 patients(63.2%)had Distant metastasis with the 1-,3-and 5-year distant metastasis rates of 12.2%,22.4%and 28.6%,respectively;and 7 patients(12.3%)had recurrence complicated with distant metastasis.The 3-,5-and 7-year 0S rates were 80.5%,64.2%and 49.9%for all patients,respectively.The median 0S was 78.4 months.The 3-,5-and 7-year PFS rates were 64.8%,49.5%and 41.5%,with a median PFS of 57.9 months(95%Cl:42.3-73.5 months).Univariate and multivariate analyses showed that biologically equivalent dose and age were the factors affecting the efficacy of SBRT(both P<0.05).Conclusion Distant metastasis is the main failure pattern in patients with T_(1-2)N_(0)M_(0)NSCLC after SBRT.High-risk population should be selected for further systematic treatment to improve the efficacy.

关 键 词：肺肿瘤 体部立体定向放射疗法 失败模式 

分 类 号：R734.2[医药卫生—肿瘤]