Ⅳ期NSCLC化疗同期三维放疗的预后再分析

Prognostic reanalysis of stage Ⅳ non-small cell lung cancer treated by chemotherapy with concurrent three-dimensional radiotherapy

目的 进一步分析Ⅳ期NSCLC化疗同期三维放疗的预后因素.方法 对2003-2010年前瞻性入组201例Ⅳ期NSCLC患者重新进行预后评价,包括依据放疗剂量＞36 Gy的159例OS的影响因素分析,以及120例PFS的影响因素分析.化疗以铂类为基础的两药联合方案,中位周期数4个.原发肿瘤中位放疗剂量63 Gy.Kaplan-Meier法计算生存率并Logrank检验,Cox模型预后多因素分析时间从最长的3年延长至5年.结果 全组201例1、2、3、5年OS及中位生存期分别为40.1％、17.3％、10.2％、5.1％及10个月.近期疗效中CR、PR、SD、PD分别为7.5％、66.0％、19.5％、6.9％,其中位生存期分别为19、13、8、6个月（P =0.000）.化疗4～5周期同期≥63 Gy与＜63 Gy患者1、2、3、5年PFS和中位生存期分别为77.4％、36.2％、27.2％、15.9％和20个月与32.6％、21.7％、0％、0％和9个月（P =0.002）.4～5周期化疗、疗后KPS稳定或增加、GTV＜ 175 cm3为OS影响因素（P=0.035、0.000、0.008）.原发肿瘤三维放疗≥63 Gy对PFS的影响接近有统计学意义（P=0.051）.结论 Ⅳ期NSCLC 4～5个周期化疗同期三维放疗≥63 Gy三维放疗使PFS、OS明显延长.

Objective To further analyze the prognostic factors in stage Ⅳ non-small cell lung cancer （NSCLC） treated by chemotherapy with concurrent three-dimensional radiotherapy.Methods We enrolled 201 patients with stage Ⅳ NSCLC in this study from January 2003 to July 2010 and analyzed overall survival （OS） in 159 patients （three-dimensional radiotherapy ＞ 36 Gy） and progression-free survival （PFS） in 120 patients.Platinum-based doublets chemotherapy was performed,and the median number of cycles was 4 ; the median dose to the planning target volume was 63 Gy.Survival rates were calculated by the Kaplan-Meier method and compared by the log-rank test.The time of multivariate prognostic analysis with the Cox model was increased from 3 years to 5 years.Results The 1-,2-,3-,and 5-year OS rates were 40.1％,17.3％,10.2％,and 5.1％,respectively,and the median survival time was 10 months.The short-term complete response,partial response,stable disease,and progressive disease rates were 7.5％,66.0％,19.5％,and 6.9％,respectively,and the median survival times were 19,13,8,and 6 months,respectively （P =0.000）.The 1-,2-,3-,and 5-year PFS rates and median survival times of patients undergoing 4 to 5 cycles of chemotherapy with radiotherapy doses of ≥63 Gy and ＜ 63 Gy were 77.4％ vs.32.6％,36.2％ vs.21.7％,27.2％ vs.0％,15.9％ vs.0％,and 20 vs.9 months,respectively （P =0.002）.According to multivariate analysis,4 to 5 cycles of chemotherapy,stable or increased Karnofsky Performance Scale score after treatment,and gross tumor volume ＜ 175 cm3 were independent prognostic factors for a better OS （P =0.035,0.000,and 0.008,respectively）.Radiation dose to the primary tumor ≥ 63 Gy resulted in a better PFS （P =0.051）,which was of borderline significance.Conclusions Chemotherapy （4-5 cycles） with concurrent three-dimensional radiotherapy （≥ 63 Gy） may significantly prolong PFS and OS in patients with stage Ⅳ NSCLC.