多原发性早期肺癌立体定向放射治疗后疗效及患者预后分析  

The efficacy and prognosis analysis after stereotactic body radiotherapy for multiple primary early-stage lung cancer

作　　者：吴晗 杨章孺[2] 冯雯 曾琬琴[2] 郭金栋 李洪选 王常禄 王家明 吕长兴 张琴 余雯[2] 蔡旭伟 傅小龙 WU Han;YANG Zhangru;FENG Wen;ZENG Wanqin;GUO Jindong;LI Hongxuan;WANG Changlu;WANG Jiaming;LÜChangxing;ZHANG Qin;YU Wen;CAI Xuwei;FU Xiaolong(School of Graduate Studies,Bengbu Medical College,Bengbu 233000,Anhui Province,China;Department of Radiation Oncology,Shanghai Chest Hospital,Shanghai Jiao Tong University School of Medicine,Shanghai 200030,China)

机构地区：[1]蚌埠医学院研究生院,安徽蚌埠233000 [2]上海交通大学医学院附属胸科医院放疗科,上海200030

出　　处：《中国癌症杂志》2023年第9期844-856,共13页China Oncology

摘　　要：背景与目的:越来越多的多原发性早期肺癌患者选择接受立体定向放射治疗(stereotactic body radiation therapy,SBRT),本研究旨在回顾性分析SBRT的疗效及预后因素。方法:符合纳入标准的2014年8月—2020年12月于上海交通大学医学院附属胸科医院接受SBRT的241例患者进入本研究,对其中的多原发性早期肺癌患者进行疗效及预后因素分析,并采用倾向性评分匹配(propensity score matching,PSM)后,观察与单原发性早期肺癌SBRT效果的差异性。结果:241例接受SBRT的早期肺癌患者纳入本研究,其中多原发性早期肺癌94例,3和5年局部控制率(local control rate,LC)、无进展生存率(progression-free survival,PFS)和总生存率(overall survival,OS)分别为87.1%和71.3%、84.0%和66.9%、93.3%和79.3%。多原发性早期肺癌患者无3级以上肺炎毒性率,合计毒性率为54.3%,24例(25.5%)患者出现2级毒性。18例(19.1%)出现复发,其中多原发性早期肺癌患者出现局部复发、区域复发、远处转移及不确定性死亡分别为3例(3.2%)、1例(1.1%)、12例(12.7%)及2例(2.1%)。PSM前,多原发性早期肺癌患者与单原发性早期肺癌患者的临床特征存在显著差异。PSM后,多原发性早期肺癌患者和单原发性早期肺癌患者各有56例,在LC(P=0.291)、PFS(P=0.954)和OS(P=0.880)方面差异无统计学意义。94例多原发性早期肺癌患者的SBRT预后因素分析显示,年龄≥70岁是多原发性早期肺癌OS的独立危险因素。同时性和异时性多原发性早期肺癌两组间差异无统计学意义(P=0.440)。对于59例首-末次治疗间隔5年内的同时性多原发性早期肺癌患者,肿瘤病灶治疗总个数差异无统计学意义(P=0.232),多次治疗中不同治疗方法差异无统计学意义(P=0.225)。结论:多原发性早期肺癌SBRT效果较好,与单原发性早期肺癌的疗效相当,SBRT可能是多原发性早期肺癌一种良好的治疗选择。今后需要探讨多原发性早期肺癌基�Background and purpose:More and more patients with multiple primary early-stage lung cancer are choosing to receive stereotactic body radiation therapy(SBRT),and this study aimed to retrospectively analyze the efficacy and prognostic factors of SBRT.Methods:In this study,patients who underwent SBRT at Shanghai Chest Hospital,Shanghai Jiao Tong University School of Medicine from August 2014 to December 2020 and who met the inclusion criteria were included.Patients with multiple primary early-stage lung cancer were examined for efficacy and prognostic factors.After using propensity score matching(PSM),the difference in efficacy of SBRT between single and multiple primary early-stage lung cancer was observed.Results:This study included 241 early-stage lung cancer patients with SBRT,including 94 patients with multiple primary early-stage lung cancer.The 3-and 5-year local control rate(LC),progression-free survival(PFS)and overall survival(OS)were 87.1%and 71.3%,84.0%and 66.9%,93.3%and 79.3%in multiple primary early-stage lung cancer,respectively.Patients with multiple primary early-stage lung cancer did not experience any grade 3 or higher pulmonary toxicity with an overall toxicity incidence of 54.3%,and grade 2 toxicity occurred in 24 patients(25.5%).There was a total of 18(19.1%)recurrences,and there were 3(3.2%),1(1.1%),12(12.7%)and 2(2.1%)patients with multiple primary early-stage lung cancers who experienced local recurrence,regional recurrence,distant metastasis and uncertain death,respectively.Patients with multiple primary early-stage lung cancer and those with single primary early-stage lung cancer had significant differences in clinical features prior to PSM.After PSM,there were 56 patients with multiple primary early-stage lung cancer and 56 patients with single primary early-stage lung cancer,and there was no statistically significant difference in LC(P=0.291),PFS(P=0.954)and OS(P=0.880).Age≥70 years was an independent risk factor for OS of multiple primary early-stage lung cancer,according to an analy

关 键 词：多原发性早期肺癌 立体定向放射治疗 倾向性评分匹配 预后 

分 类 号：R734.2[医药卫生—肿瘤]