转移部位不同对广泛期小细胞肺癌胸部放疗价值的影响

Implications of different metastatic sites for thoracic radiation in extensive-stage small cell lung cancer

目的分析胸部放疗在不同转移部位的广泛期小细胞肺癌(ES-SCLC)患者中的治疗价值。方法回顾性分析2010—2019年间就诊于天津医科大学肿瘤医院首诊ES-SCLC患者,其中化疗后病情无进展病例830例纳入分析。所有患者均一线接受了含铂方案化疗,341例患者接受了胸部放疗。主要观察终点为总生存(OS),采用卡方检验对性别、年龄等分类数据进行比较,采用Kaplan-Meier方法计算OS且log-rank检验,用Cox多因素回归分析评估影响患者OS的风险因素。结果与未接受胸部放疗组相比,胸部放疗显著改善了患者的OS(中位OS为15.2个月∶10.8个月,P<0.001)。亚组分析中寡转移组无肝转移患者接受胸部放疗明显改善OS(中位OS为16.0月∶11.4月,P<0.001),有肝转移患者接受胸部放疗OS似乎有所提高(中位OS为14.2个月∶10.6个月,P=0.072)。多发转移组中无肝转移患者胸部放疗后OS明显改善(中位OS为14.5个月∶10.9个月,P<0.001),而有肝转移患者接受胸部放疗预后无明显改善(中位OS为10.2个月∶9.2个月,P=0.715)。结论在ES-SCLC患者中寡转移组无肝转移患者接受胸部放疗OS明显获益,肝转移患者在化疗有效基础上胸部放疗也有可能有生存获益;而在多发转移患者中胸部放疗仅改善了无肝转移患者OS,而未改善有肝转移患者预后。

Objective To evaluate the efficacy and safety of thoracic radiotherapy in the treatment of patients with extensive-stage small cell lung cancer(ES-SCLC)with different metastatic sites.Methods A retrospective analysis was performed among 830 ES-SCLC patients who were admitted to our hospital from 2010 to 2019.They all received the first-line chemotherapy and had no progression after chemotherapy.341 patients of them received thoracic radiotherapy after chemotherapy.The main endpoint was overall survival.The Chi-square test was used to compare the categorical data including gender and age,etc.Univariate survival analysis was estimated by Kaplan-Meier method and the log-rank test was used to compare the survival curves between two groups.A multivariate prognostic analysis was made by the Cox proportional hazard model.Results In all the patients,the overall survival(OS)was 12.4 months.The patients with thoracic radiotherapy had significantly higher OS than the patients without thoracic radiotherapy(15.2 months vs.10.8 months,P<0.001).Thoracic radiotherapy significantly improved the OS in patients without liver metastasis(16.0 months vs.11.4 months,P<0.001)in the oligometastatic patients.But for the oligometastatic patients with liver metastasis,the OS benefit was not significant(14.2 months vs.10.6 months,P=0.072).For polymetastatic patients without liver metastasis,thoracic radiotherapy offered significant OS benefits(14.5 months vs.10.9 months,P<0.001),but for the polymetastatic patients with liver metastasis,the OS was not improved with thoracic radiotherapy(10.2 months vs.9.2 months,P=0.715).Conclusions In ES-SCLC patients,thoracic radiotherapy provides significant OS benefits in patients with oligometastases ES-SCLC without liver metastasis and for the liver metastatic patients may also benefit from thoracic radiotherapy based on the effectiveness of chemotherapy.In patients with multiple metastases,thoracic radiotherapy only improves the OS in patients without liver metastasis,but does not improve the prognosis in patients with liver metastasis.