Ⅳ期肺鳞癌三维放疗对生存的影响

Effect of three-dimensional radiotherapy on the survival of patients with stage IV squamous cell lungcancer

目的 回顾性分析Ⅳ期肺鳞癌原发肿瘤三维放疗对生存的影响。方法 病例源自2项前瞻Ⅱ期临床研究,101例鳞癌中完成研究方案88例,原发肿瘤为化疗同期三维放疗。主要观察终点为OS和PFS。Kaplan-Meier计算生存率并Logrank检验和单因素分析,Cox模型多因素分析。结果 88例鳞癌患者1、2、3、5年OS和MST分别为42.2%、13.6%、8.7%、3.1%和10个月,≥63 Gy和〈63 Gy的1、2、3、5年OS及MST分别为45.7%和39.6%、25.7%和4.5%、17.1%和2.8%、7.1%和0%及11月和10个月（P=0.007）;中位PFS分别为9个月和7个月（P=0.032）。4周期化疗同期原发肿瘤剂量≥63 Gy的1、2、3、5年OS和PFS分别为51.9%、29.6%、18.5%、9.9%和9个月,OS和PFS较其他模式显著延长（P=0.001、0.012）;多因素分析原发肿瘤剂量≥63 Gy对OS有影响接近统计学意义（P=0.080）。结论 Ⅳ期肺鳞癌原发肿瘤三维放疗可能延长生存,随放化疗强度提高OS和PFS逐渐延长,原发肿瘤≥63 Gy可能影响OS。

Objective To retrospectively analyze the effect of three-dimensional radiotherapy on the survival of patients with stage Ⅳ squamous cell lung cancer. Methods Of the 101 patients collected from two prospective phase Ⅱ studies, 88 were part of the per-protocol set. All patients received platinum-doublet chemotherapy with concurrent radiation to the primary tumor. Primary endpoints were overall survival （OS） and progression-free survival （PFS）. Survival was calculated using the Kaplan-Meier estimator, and univariate and multivariate analyses were performed using the log-rank test and Cox model, respectively. Results The 1-, 2-, 3-, and 5-year OS rates of the 88 patients were 42.2%, 13.6%, 8.7%, and 3.1%, respectively, and the median survival time （MST） was 10 months. The 1-, 2-, 3-, and 5-year OS and MST at PTV dose ≥63 Gy were 45.7%, 25.7%, 17.1%, 7.1%, and 11 months, respectively, whereas the 1-, 2-, 3-, and 5-year OS and MST at PTV dose〈63 Gy were 39.6%, 4.5%, 2.8%, 0%, and 10 months, respectively （P=0.007）. The median PFS at ≥63 Gy and〈63 Gy were 9 months and 7 months, respectively （P=0.032）. The 1-, 2-, 3-, and 5-year OS and PFS of patients who received 4 cycles of chemotherapy at a PTV dose of ≥63 Gy were 51.9%, 29.6%, 18.5%, 9.9%, and 9 months, respectively （P=0.001 and P=0.012）, which were significantly prolonged compared with other treatment modalities. Multivariate analysis showed that PTV ≥63 Gy may be influence the OS of patients （P=0.080）. Conclusions Three-dimensional radiotherapy can prolong the survival of patients with stage ⅠV squamous cell lung cancer, as demonstrated by the gradual improvement in OS and PFS following the increase in the intensity of concurrent chemotherapy and radiation therapy. A PTV dose of ≥63 Gy may be influence the OS.