109例早期非小细胞肺癌SABR预后分析

Analysis of clinical outcomes and prognostic factors in 109 patients with early-stage non-small cell lung cancer treated with stereotactic ablation radiotherapy

目的评估立体定向消融放疗(SABR)在早期非小细胞肺癌(ES-NSCLC)中疗效及预后影响因素。方法分析2011-2018年间在河南省肿瘤医院接受SABR治疗的109例ES-NSCLC患者资料,采用Kaplan-Meier法计算总生存(OS)、癌症特异生存(CSS)、无进展生存(PFS)率,log-rank检验和单因素分析,Cox模型多因素分析。结果109例ES-NSCLC患者,中位随访时间44个月(2~93个月),中位OS、CSS、PFS期分别为78、78、44个月。1,3,5年OS、CSS、PFS率分别为95.4%、97.2%、84.1%,75.6%、79.1%、56.6%,55.6%、60.7%、37.3%。单因素分析显示ECOG评分、年龄、吸烟史和疗前改进型中性粒细胞-淋巴细胞比率(dNLR)是影响OS因素(P=0.03、0.02、0.04、0.001);年龄、吸烟史和dNLR是影响CSS因素(P=0.02、0.03、0.001);未发现PFS的预后影响因素。多因素分析显示dNLR是OS、CSS的独立预后因素(P=0.001、0.001)。结论ES-NSCLC患者行SABR可获得较好的生存;dNLR可以考虑在临床上应用监测患者预后。

Objective To evaluate the long-term survival and identify prognostic factors of patients diagnosed with early-stage non-small cell lung cancer(ES-NSCLC)receiving stereotactic ablation radiotherapy(SABR).Methods Clinical data of 109 ES-NSCLC patients treated with SABR in Henan Cancer Hospital from 2011 to 2018 were retrospectively analyzed.The overall survival(OS),cancer-specific survival(CSS)and progression-free survival(PFS)were calculated by Kaplan-Meier method and log-rank test.Multivariate prognostic analysis was performed by Cox regression model.Results The median follow-up time was 44 months(2-93 months).The median OS,CSS and PFS were 78 months,78 months and 44 months,respectively.The 1-year OS,CSS and PFS were 95.4%,97.2%and 84.1%,and 75.6%,79.1%and 56.6%for the 3-year OS,CSS and PFS,and 55.6%,60.7%and 37.3%for the 5-year OS,CSS and PFS,respectively.Univariate analysis showed that ECOG score,age,smoking history and derived-neutrophil/lymphocyte ratio(dNLR)were the influencing factors of OS(P=0.03,0.02,0.04,0.001).Age,smoking history and dNLR were the influencing factors of CSS(P=0.02,0.03,0.001).Multivariate analysis demonstrated that dNLR was an independent prognostic factor for OS and CSS(P=0.001,0.001).Conclusions ES-NSCLC patients treated with SABR can achieve favorable survival.The dNLR is an independent prognostic factor of OS and CSS,which can be considered in clinical application.