免疫细胞照射剂量对不同负荷局限期小细胞肺癌预后影响

Prognostic impacts of the estimated dose of radiation to immune cells(EDRIC)on limited-stage small-cell lung cancer with different tumor burdens

目的研究免疫细胞照射剂量(EDRIC)对不同肿瘤负荷局限期小细胞肺癌(LS-SCLC)总生存(OS)、局部无进展生存(LPFS)和无远处转移生存(DMFS)的影响。方法回顾性分析2013—2019年在天津医科大学肿瘤医院初治的216例接受了根治性胸部常规分割放疗的LS-SCLC患者资料。根据Jin等建立的模型计算EDRIC,依据大体肿瘤体积(GTV)或临床分期评估肿瘤负荷。研究终点为OS、LPFS和DMFS,从确诊时开始计算。使用R语言计算EDRIC最佳截断值,Spearman相关分析评估EDRIC与肿瘤负荷相关性,Cox模型及Kaplan-Meier法进行生存分析。结果全组患者中位随访时间47.8个月,中位OS、DMFS为34.6、18.5个月,中位LPFS未达到。EDRIC最佳截断值为6.8 Gy。Cox多因素分析显示EDRIC是影响OS、DMFS的独立预后因素。EDRIC与GTV或临床分期弱相关,以GTV中位值分层,在GTV≤34.6 cm3组中,EDRIC>6.8 Gy组OS(P=0.021)和DMFS(P=0.030)比EDRIC≤6.8 Gy组显著缩短,LPFS有缩短趋势(P=0.107);而在GTV>34.6 cm3组,EDRIC变化对OS、LPFS、DMFS影响不大(P=0.133、0.420、0.374)。以临床分期分层,在Ⅰ、Ⅱ、ⅢA期患者中,EDRIC>6.8 Gy组OS(P=0.003)和DMFS(P=0.032)比EDRIC≤6.8 Gy组显著缩短,LPFS有缩短趋势(P=0.125);而在ⅢB、ⅢC期患者中,EDRIC变化对OS、LPFS、DMFS影响不大(P=0.377、0.439、0.484)。结论 EDRIC是影响预后的重要因素,并且在肿瘤负荷较小的患者中,对预后影响更显著。

Objective To investigate the effects of estimated dose of radiation to immune cells(EDRIC)on overall survival(OS),local progression-free survival(LPFS)and distant metastasis-free survival(DMFS)in limited-stage small-cell lung cancer(LS-SCLC)with different tumor burdens.Methods Clinical data of 216 patients with LS-SCLC who initially received conventional fractionated radiotherapy of the chest for radical treatment in Tianjin Medical University Cancer Institute and Hospital from 2013 to 2019 were retrospectively analyzed.EDRIC was calculated based on the model developed by Jin et al.and tumor burdens were assessed by gross tumor volume(GTV)or clinical stage.The study endpoints were OS,LPFS and DMFS,which were calculated from the date of diagnosis.The optimal cut-off value of EDRIC was calculated by R language.The correlation between EDRIC and tumor burdens was analyzed using Spearman's correlations.Survival analysis was performed by Cox proportional hazards regression model and Kaplan-Meier curve.Results The median follow-up time for the whole group was 47.8 months,and the median OS and DMFS was 34.6 months and 18.5 months,respectively,while the median LPFS did not reach.The optimal cut-off value of EDRIC was 6.8 Gy.Cox multivariate analysis showed that EDRIC was an independent prognostic factor affecting OS and DMFS.EDRIC was weakly correlated with GTV or clinical stage.Stratified by the median GTV,OS(P=0.021)and DMFS(P=0.030)were significantly shortened and LPFS had a tendency of shortening(P=0.107)when EDRIC>6.8 Gy compared with those when EDRIC≤6.8 Gy in the GTV≤34.6 cm3 group;EDRIC had little effect on OS,LPFS,and DMFS(P=0.133,0.420,0.374)in the GTV>34.6 cm3 group.Stratified by clinical stage,OS(P=0.003)and DMFS(P=0.032)were significantly shortened and LPFS(P=0.125)tended to shorten when EDRIC>6.8 Gy in stage I,II and IIIA groups;EDRIC exerted slight effect on OS,LPFS,and DMFS(P=0.377,0.439,0.484)in stage IIIB and IIIC groups.Conclusion EDRIC is an important factor affecting prognosis and exerts more significant impact on prognosis in patients with smaller tumor burden.