肺部原发灶姑息性放射治疗在Ⅳ期非小细胞肺癌中的作用

The Impact of Palliative Thoracic Radiotherapy for Patients with Stage Ⅳ Non-small Cell Lung Cancer

[目的]评价肺部原发灶姑息性放射治疗在Ⅳ期非小细胞肺癌中的作用。[方法]回顾性分析接受肺部原发灶姑息性放射治疗的119例初治Ⅳ期非小细胞肺癌。研究患者一般情况、疾病特点和治疗因素与预后的相关性;并根据转移灶数目分为寡转移（OMT,1-4个转移灶）和多转移（PMT,≥5个转移灶）两组,探讨治疗因素对两组患者生存的影响。采用KaplanMeier法计算生存率,Log-rank法行单因素分析,Cox回归模型行多因素分析。[结果 ]全组中位生存时间为14.1个月。寡转移组中位生存时间为15.9个月,多转移组中位生存时间为13.4个月。单因素分析提示性别（P=0.002）、吸烟指数（P=0.007）和一般状况评分（P=0.000）与预后显著相关,原发灶≥60Gy的高剂量放射治疗（P=0.063）和化疗（P=0.054）有提高全组患者总生存的趋势。多因素分析提示全身化疗（P=0.015）、PS评分（P=0.000）和性别（P=0.006）是影响患者预后的独立因素。在分层分析中,寡转移组患者原发灶≥60Gy高剂量放射治疗（P=0.030）和接受化疗（P=0.030）有明显的生存获益。[结论 ]对于寡转移的晚期非小细胞肺癌患者,在积极全身治疗的同时,加强原发灶局部放射治疗可改善生存。

[Objective] To evaluate the value of palliative thoracic radiotherapy for patients with stage Ⅳ non-small cell lung cancer. [Methods] 119 patients with stage Ⅳ non-small cell lung cancer treated with palliative thoracic radiotherapy were enrolled in this retrospective study. The prognosis factors including the patients＇ general condition,disease characteristics and treatment factors were analyzed. Patients were divided into two groups based on the number of distant metastases（Oligometastasis,OMT,1-4 metastases; Polymetastasis,PMT,〉5 metastases）. The relationship between the prognosis and treatment factors was explored. Overall survival was estimated using the Kaplan-Meier method,and prognostic factors were identified by univariate and multivariate analysis. [Results] The median survival time was 14.1 months. Gender（P=0.002）,smoking index（P=0.007） and PS（P=0.000）were significantly associated with prognosis under univariate analysis. There was marginally significant associated with prognosis for those patients who received chemotherapy（P =0.054） and received a sufficient dose of thoracic radiotherapy（at least60Gy）（P=0.063）. On multiplicity analysis,gender（P=0.006）,PS（P=0.000） and chemotherapy（P=0.015）retained significance. In the hierarchical analysis,patients who received at least 60 Gy of thoracic radiotherapy（P=0.030） and received chemotherapy（P=0.030） achieved better overall survival in the OMT group. [Conclusion] For the patients with OMT,local treatment may improve overall survival.