原发肿瘤体积对IV期非小细胞肺癌生存影响--来自多中心Ⅱ期前瞻性临床研究结果再分析

Influence of survival in primary tumor volume for stage IV non-small cell lung cancer on survival-re-analysis of phase II multicenter prospective clinical findings

目的探讨Ⅳ期非小细胞肺癌(NSCLC)原发肿瘤三维放疗的原发肿瘤体积对生存的影响。方法2002-2017年一项多中心前瞻性临床研究再分析入组患者428例,可生存分析423例。化疗以铂类为基础的二药联合方案,中位化疗4个周期,PTV分界值63 Gy,GTV分界值150 cm3。结果Cox模型预后分析发现女性、治疗后KPS评分、单器官转移、N0-N1期、腺癌、放疗≥63 Gy、4~6个周期化疗、近期有效、治疗后进展服用靶向药物、GTV体积<150 cm3是良好预后因素(P均<0.05)。根据不同化放疗方案分层分析发现GTV体积≥150 cm3全身化疗基础上联合原发肿瘤放疗剂量≥63 Gy生存优于放疗剂量<63 Gy (P<0.05)。结论Ⅳ期NSCLC患者GTV体积≥150 cm3,行4~6个周期化疗联合PTV放疗≥63 Gy和GTV体积<150 cm3,行1~3个周期化疗联合PTV放疗≥63 Gy也许延长Ⅳ期NSCLC患者总生存。

Objective To investigate the effect of primary tumor volume on the survival in the three-dimensional radiotherapy of primary tumors of stage Ⅳ non-small cell lung cancer (NSCLC). Methods Clinical data of 428 patients in a multicenter prospective clinical study from December 2002 to January 2017 were reanalyzed, and 423 of them were subject to survival analyses. Platinum-based doublet chemotherapy was adopted. The median number of chemotherapy cycle was 4, and the critical value of planning target volume (PTV) of primary tumors was 63 Gy. The critical value of gross tumor volume (GTV) of primary tumors was 150 cm3. Results Single factor Cox regression analysis demonstrated that female, KPS score, single organ metastasis, N0-N1 staging, adenocarcinoma, radiotherapy dose ≥63 Gy, 4-6 cycles of chemotherapy, recent effectiveness, post-treatment progress in taking targeted drugs and GTV<150 cm3 were good prognostic factors for the patients with stage Ⅳ NSCLC (all P<0.05). According to the stratified analysis of different radiotherapy regimes, for the stage Ⅳ NSCLC patients with a GTV ≥150 cm3, the survival rate of the primary tumor radiotherapy dose ≥63 Gy on the basis of systemic chemotherapy was significantly better than that of the primary tumor radiotherapy dose <63 Gy (P<0.05). Conclusions Stage Ⅳ NSCLC patients with GTV≥150 cm3 in 4-6 cycles of chemotherapies combined with primary tumor radiotherapy dose ≥63 Gy and GTV<150 cm3 in 1-3 cycles of chemotherapies combined with primary tumor radiotherapy dose ≥63 Gy may prolong the overall survival of patients with stage Ⅳ NSCLC.