非小细胞肺癌原发灶和转移灶对化疗反应差异研究

Response discrepancy of primary and corresponding metastasis lesions to systemic chemotherapy in advanced non-small cell lung cancer

目的肿瘤乏氧、体积等差异可导致其对相同治疗的不同疗效,本研究旨在回顾性分析晚期非小细胞肺癌(nonsmall cell lung cancer,NSCLC)原发灶及其相应转移灶对全身化疗的反应性差异。方法选择重庆医科大学附属第一医院2011-01-01-2016-12-31收治的晚期NSCLC并发肺内或相应纵膈淋巴结转移患者978例,所有患者均行2个周期以铂类为基础的双药联合全身化疗。实体瘤疗效评价标准(response evaluation criteria in solid tumors,RECIST)用于评估原发灶及转移灶化疗后肿瘤退缩情况,Logistic回归分析用于评价原发灶及相应转移灶对全身化疗反应性差异的相关影响因素。结果结果表明,与原发灶相比,肺内转移灶(P=0.020)和相应纵膈淋巴结转移灶(P<0.001)对全身化疗反应更敏感,能达到更好的退缩。单因素Logistic回归分析指出,性别(OR=0.647,95%CI=0.485~0.864,P=0.035)、吸烟(OR=1.326,95%CI=1.014~1.773,P=0.046)、组织学类型为鳞癌(OR=0.646,95%CI=0.493~0.844,P=0.002)及原发灶部位(OR=0.673,95%CI=0.521~0.869,P=0.003)等因素可导致原发灶及相应转移灶对全身化疗的反应性差异。而多因素Logistic回归分析结果指出,仅原发灶部位(P=0.028)及组织学类型(P=0.026)是肺癌患者原发灶及转移灶对全身化疗差异性反应的相关影响因素。结论与原发灶相比,晚期NSCLC患者中肺内转移灶及纵膈转移淋巴结对全身化疗的退缩更好,为该亚群患者最佳治疗方案的选择提供了理论依据。

OBJECTIVE The difference of tumor hypoxia and tumor volume can result in the different curative effects to the same treatment.The aim of this study was to retrospectively analyze the response discrepancy to systemic chemotherapy of primary and corresponding metastasis lesions in non-small cell lung cancer（NSCLC）.METHODS Patients of advanced NSCLC complicated with intrapulmonary or corresponding mediastinal lymph nodes metastasis were admitted in this cohort between January 1,2011 and December 31,2016.Totally 978 patients were considered eligible and platinum-based two-drug systemic chemotherapy regimens were undergone for two cycles.Response evaluation criteria in solid tumors（RECIST）was used to assess the shrink of both primary and metastasis lesions,and logistic regression analysis was used to determine the independent impact factors of the response to systemic chemotherapy in both primary and corresponding metastasis lesions.RESULTS Our results indicated that the intrapulmonary（P=0.020）and mediastinal lymph nodes metastasis lesions got a better shrink（P0.001）compared to primary lesion of these patients when undergone systemic chemotherapy.Univariate logistic analysis indicated that gender（OR=0.647,95% CI=0.485-0.864,P=0.035）,smoking（OR=1.326,95% CI=1.014-1.773,P=0.046）,histology of squamous（OR=0.646,95% CI=0.493-0.844,P=0.002）also the location of primary lesion（OR=0.673,95% CI=0.521-0.869,P=0.003）could influence the shrink discrepancy in primary and corresponding metastasis lesions,nevertheless,the multivariate logistic analysis demonstrated that the primary lesion only in central type carcinoma（P=0.028）as well asand the squamous carcinoma subgroups（P=0.026）as had a poorer response to systemic chemotherapy.CONCLUSIONS Intrapulmonary or mediastinal lymph nodes metastasis lesions had better response to chemotherapy compared to primary lesions in advanced NSCLC patients,which provided as the basis for the choose of optimal treatments in the subgroup of patients except distant metastasis with advanced NSCLC.