| 摘要: |
| 目的 评估晚期非小细胞肺癌(NSCLC)寡转移（转移器官≤3个，转移病灶≤5个）的患者系统治疗联合局部治疗效果，分析影响患者预后的相关因素。方法 回顾性分析2018年2月至2021年12月我院收治的149例晚期NSCLC寡转移患者。根据入组的患者系统治疗原发病灶稳定的基础上是否联合局部治疗分为研究组(A组)和对照组(B组)。A组患者接受系统治疗联合局部治疗，局部治疗包括立体定向放疗(stereotactic body radiation therapy,SBRT)和调强适形放疗(intensity-modulated conformal radiotherapy，IMRT)。接受SBRT的患者47例，处方剂量48～52 Gy，治疗4～5次。接受IMRT的患者42例，处方剂量60～65 Gy，治疗25～30次。B组患者60例，接受系统治疗。系统治疗包括化疗、靶向治疗、使用免疫检查点抑制剂(immune checkpoint inhibitors,ICIs)和抗血管生成药物等。主要研究终点为无进展生存期(PFS)，次要研究终点为总生存期(OS)。采用Kaplan-Meier对两组患者的PFS和OS进行生存分析并绘制生存曲线，Log-rank检验比较组间生存期的差异，Cox回归对PFS和OS进行单因素和多因素分析。结果 149例患者中位随访时间20.0 (12.0，32.0) 个月。A组和B组患者的PFS分别为14.7(12.3，16.7)个月和6.5(4.0，6.7)个月(HR=7.69, 95%CI 5.00～11.11)。A组和B组患者的OS分别为28.4(18.0，36.5)个月和16.1(11.3，24.7)个月(HR=1.78, 95%CI 1.19～2.63)。亚组分析发现，SBRT组和IMRT组患者的PFS分别为16.7(14.0，18.3)个月和13.7(12.0，14.5)个月(HR=2.43, 95%CI 1.54～3.84)，OS分别为28.0(19.3，36.8)个月和25.4(10.3，43.1)个月(HR=2.04, 95%CI 1.22～3.33)。多因素分析发现，颅内转移是PFS的危险因素。寡转移分组、脑转移分组、组织类型、ICIs、驱动基因、抗血管生成和局部治疗方式是OS的影响因素。结论 对晚期NSCLC寡转移原发病灶稳定的患者，局部放疗联合系统治疗较单用系统治疗显著改善PFS和OS，SBRT显著优于IMRT；颅内转移是不良预后因素。 |
| 关键词: 非小细胞肺癌 寡转移 立体定向放射治疗 局部治疗 疗效 |
| DOI：10.12025/j.issn.1008-6358.2023.20230640 |
| 分类号: |
| 基金项目:国家自然科学基金(82272748). |
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| Analysis of the efficacy of systemic therapy combined with local therapy in patients with oligometastasis of non-small cell lung cancer |
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DU Qian-qian1, LI Guo-quan2, ZHANG Gui-yu1, ZHANG Sheng2, YANG Yu-mei1
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1.Department of Respiratory and Critical Care Medicine, Tian You Hospital, Wuhan University of Science and Technology, Wuhan 430064, Hubei, China;2.Cancer Center, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, Hubei, China
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| Abstract: |
| Objective To explore the effectiveness of systemic therapy combined with local therapy for advanced patients with oligometastasis non-small cell lung cancer (NSCLC), and to analyze the factors associated with the prognosis of the patients. Methods Retrospective analysis of 149 patients with advanced NSCLC oligometastasis admitted to Tian You Hospital of Wuhan University of Science and Technology from February 2018 to December 2021. Oligometastasis was defined as ≤3 metastatic organs and ≤5 metastatic lesions. Divide the enrolled patients into a study group (group A) and a control group (group B) based on whether to combine local treatment with stable primary lesions after systematic treatment.Patients in group A received systemic therapy in combination with local treatment,which included stereotactic radiotherapy(SBRT) and intensity-modulated conformal radiotherapy (IMRT). Forty-seven patients received SBRT at a prescribed dose of 48-52 Gy for 4-5 fractions.Forty-two patients received a dose of 60-65 Gy for 25-30 fractions.Sixty patients in group B received systemic therapy.Systemic therapy included chemotherapy,targeted therapy, immune checkpoint inhibitors (ICIs), and anti-angiogenesis.The primary endpoint of the study was progression-free survival (PFS) and the secondary endpoint was overall survival (OS). Survival analysis and survival curve plots were performed using the Kaplan-Meier method for PFS and OS in both groups,the Log-rank test to compare the difference in survival between groups,the Kaplan-Meier method and Cox regression for univariate and multifactorial analysis of PFS and OS. Results The median follow-up time was 20.0 (12.0,32.0) months in 149 patients. PFS was 14.7 (12.3, 16.7) months and 6.5 (4.0, 6.7) months in group A and B patients, respectively (HR=7.69, 95%CI 5.00-11.11). The OS of patients in group A and group B was 28.4 (18.0, 36.5) months and 16.1 (11.3, 24.7) months, respectively (HR=1.78, 95%CI 1.19-2.63). In subgroup analysis, patients in the SBRT and IMRT groups had a PFS of 16.7 (14.0, 18.3) months and 13.7 (12.0,14.5) months (HR=2.43, 95%CI 1.54-3.84) and OS of 28.0 (19.3, 36.8) and 25.4 (10.3, 43.1) months (HR=2.04, 95%CI 1.22-3.33), respectively. Multifactorial analysis of intracranial metastases was a risk factor for PFS. Oligometastatic subgroup, brain metastatic subgroup, tissue type, ICIs, driver genes, anti-angiogenesis and local treatment modality were influential factors affecting OS. Conclusions In patients with stable oligometastases in advanced NSCLC, local radiotherapy combined with systemic therapy significantly improves PFS and OS compared with systemic therapy alone, and SBRT is significantly better than IMRT.Intracranial metastasis is a poor prognostic factor. |
| Key words: non-small cell lung cancer oligometastases stereotactic body radiotherapy local therapy efficacy |
