The efficacy and prognosis analysis after stereotactic body radiotherapy for multiple primary early-stage lung cancer

Han WU; Zhangru YANG; Wen FENG; Wanqin ZENG; Jindong GUO; Hongxuan LI; Changlu WANG; Jiaming WANG; Changxing LÜ; Qin ZHANG; Wen YU; Xuwei CAI; Xiaolong FU

doi:10.19401/j.cnki.1007-3639.2023.09.005

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The efficacy and prognosis analysis after stereotactic body radiotherapy for multiple primary early-stage lung cancer

Article | 更新时间：2025-12-31

- The efficacy and prognosis analysis after stereotactic body radiotherapy for multiple primary early-stage lung cancer
- China Oncology Vol. 33, Issue 9, Pages: 844-856(2023)
- 作者机构：
  
  1. 蚌埠医学院研究生院，安徽蚌埠 233000
  2. 上海交通大学医学院附属胸科医院放疗科，上海 200030
- 作者简介：
- 基金信息：
- DOI：10.19401/j.cnki.1007-3639.2023.09.005
  CLC： R734.2
- Received：24 April 2023，
  
  Revised：2023-07-01，
  
  Published：30 September 2023
- 稿件说明：
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Han WU, Zhangru YANG, Wen FENG, et al. The efficacy and prognosis analysis after stereotactic body radiotherapy for multiple primary early-stage lung cancer[J]. China Oncology, 2023, 33(9): 844-856.
DOI：

Han WU, Zhangru YANG, Wen FENG, et al. The efficacy and prognosis analysis after stereotactic body radiotherapy for multiple primary early-stage lung cancer[J]. China Oncology, 2023, 33(9): 844-856. DOI： 10.19401/j.cnki.1007-3639.2023.09.005.

摘要

背景与目的：

越来越多的多原发性早期肺癌患者选择接受立体定向放射治疗（stereotac

tic body radiation therapy，SBRT），本研究旨在回顾性分析SBRT的疗效及预后因素。

方法：

符合纳入标准的2014年8月—2020年12月于上海交通大学医学院附属胸科医院接受SBRT的241例患者进入本研究，对其中的多原发性早期肺癌患者进行疗效及预后因素分析，并采用倾向性评分匹配（propensity score matching，PSM）后，观察与单原发性早期肺癌SBRT效果的差异性。

结果：

241例接受SBRT的早期肺癌患者纳入本研究，其中多原发性早期肺癌94例，3和5年局部控制率（local control rate，LC）、无进展生存率（progression-free survival，PFS）和总生存率（overall survival，OS）分别为87.1%和71.3%、84.0%和66.9%、93.3%和79.3%。多原发性早期肺癌患者无3级以上肺炎毒性率，合计毒性率为54.3%，24例（25.5%）患者出现2级毒性。18例（19.1%）出现复发，其中多原发性早期肺癌患者出现局部复发、区域复发、远处转移及不确定性死亡分别为3例（3.2%）、1例（1.1%）、12例（12.7%）及2例（2.1%）。PSM前，多原发性早期肺癌患者与单原发性早期肺癌患者的临床特征存在显著差异。PSM后，多原发性早期肺癌患者和单原发性早期肺癌患者各有56例，在LC（

= 0.291）、PFS（

= 0.954）和OS（

= 0.880）方面差异无统计学意义。94例多原发性早期肺癌患者的SBRT预后因素分析显示，年龄≥70岁是多原发性早期肺癌OS的独立危险因素。同时性和异时性多原发性早期肺癌两组间差异无统计学意义（

= 0.440）。对于59例首-末次治疗间隔5年内的同时性多原发性早期肺癌患者，肿瘤病灶治疗总个数差异无统计学意义（

= 0.232），多次治疗中不同治疗方法差异无统计学意义（

= 0.225）。

结论：

多原发性早期肺癌SBRT效果较好，与单原发性早期肺癌的疗效相当，SBRT可能是多原发性早期肺癌一种良好的治疗选择。今后需要探讨多原发性早期肺癌基于年龄和肿瘤生物学行为的病灶局部干预策略和技术。

Abstract

Background and purpose:

More and more patients with multiple primary early-stage lung cancer are choosing to receive stereotactic body radiation therapy (SBRT)

and this study aimed to retrospectively analyze the efficacy and prognostic factors of SBRT.

Methods:

In this study

patients who underwent SBRT at Shanghai Chest Hospital

Shanghai Jiao Tong University School of Medicine from August 2014 to December 2020 and who met the inclusion criteria were included. Patients with multiple primary early-stage lung cancer were examined for efficacy and prognostic factors. After using propensity score matching (PSM)

the difference in efficacy of SBRT between single and multiple primary early-stage lung cancer was observed.

Results:

This study included 241 early-stage lung cancer patients with SBRT

including 94 patients with multiple primary e

arly-stage lung cancer. The 3- and 5-year local control rate (LC)

progression-free survival (PFS) and overall survival (OS) were 87.1% and 71.3%

84.0% and 66.9%

93.3% and 79.3% in multiple primary early-stage lung cancer

respectively. Patients with multiple primary early-stage lung cancer did not experience any grade 3 or higher pulmonary toxicity with an overall toxicity incidence of 54.3%

and grade 2 toxicity occurred in 24 patients (25.5%). There was a total of 18 (19.1%) recurrences

and there were 3 (3.2%)

1 (1.1%)

12 (12.7%) and 2 (2.1%) patients with multiple primary early-stage lung cancers who experienced local recurrence

regional recurrence

distant metastasis and uncertain death

respectively. Patients with multiple primary early-stage lung cancer and those with single primary early-stage lung cancer had significant differences in clinical features prior to PSM. After PSM

there were 56 patients with multiple primary early-stage lung cancer and 56 patients with single primary early-stage lung cancer

and there was no statistically significant difference in LC (

= 0.291)

PFS (

= 0.954) and OS (

= 0.880). Age≥70 years was an independent risk factor for OS of multiple primary early-stage lung cancer

according to an analysis of the prognostic variables of SBRT in 94 patients with multiple primary early-stage lung cancer. Regarding synchronous (≤180 d) and metachronous (

180 d) multiple primary early-stage lung cancer

there was no discernible difference between the two groups (

= 0.440). There was no significant difference in the total number of treatments for multiple primary early-stage lung cancer (

= 0.232) and no significant difference in the type of treatment for multiple primary early-stage lung cancer (

= 0.225) among 59 patients with synchronous multiple primary early-stage lung cancer within 5 years of the first-to-last treatment interval.

Conclusion:

SBRT has a st

rong and comparable efficacy for multiple primary early-stage lung cancer compared with single primary early-stage lung cancer

making it a viable treatment choice. Based on age and tumor biological behavior of the lesion

future strategies and procedures for local intervention of multiple primary early-stage lung cancer need to be investigated.

关键词

Keywords

references

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