多原发性早期肺癌立体定向放射治疗后疗效及患者预后分析

吴晗; 杨章孺; 冯雯; 曾琬琴; 郭金栋; 李洪选; 王常禄; 王家明; 吕长兴; 张琴; 余雯; 蔡旭伟; 傅小龙

doi:10.19401/j.cnki.1007-3639.2023.09.005

您当前的位置：

首页 >

文章列表页 >

多原发性早期肺癌立体定向放射治疗后疗效及患者预后分析

论著 | 更新时间：2025-12-31

- 多原发性早期肺癌立体定向放射治疗后疗效及患者预后分析
- The efficacy and prognosis analysis after stereotactic body radiotherapy for multiple primary early-stage lung cancer
- 中国癌症杂志 2023年33卷第9期页码：844-856
- 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：
  
  [ "吴晗（ORCID: 0009-0003-2087-184X），硕士在读。" ]
  傅小龙（ORCID: 0000-0001-8127-3884），博士，主任医师、教授，上海交通大学医学院附属胸科医院放疗科主任。
- 基金信息：
- DOI：10.19401/j.cnki.1007-3639.2023.09.005
  中图分类号： R734.2
- 收稿：2023-04-24，
  
  修回：2023-07-01，
  
  纸质出版：2023-09-30
- 稿件说明：
移动端阅览
吴晗, 杨章孺, 冯雯, 等. 多原发性早期肺癌立体定向放射治疗后疗效及患者预后分析[J]. 中国癌症杂志, 2023,33(9):844-856.

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.
吴晗, 杨章孺, 冯雯, 等. 多原发性早期肺癌立体定向放射治疗后疗效及患者预后分析[J]. 中国癌症杂志, 2023,33(9):844-856. DOI： 10.19401/j.cnki.1007-3639.2023.09.005.

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

SIEGEL R , MA J M , ZOU Z H , et al . Cancer statistics, 2014 [J ] . CA A Cancer J Clin , 2014 , 64 ( 1 ): 9 - 29 . DOI: 10.3322/caac.v64.1 http://doi.org/10.3322/caac.v64.1 https://acsjournals.onlinelibrary.wiley.com/toc/15424863/64/1 https://acsjournals.onlinelibrary.wiley.com/toc/15424863/64/1

ZENG H M , RAN X H , AN L , et al . Disparities in stage at diagnosis for five common cancers in China: a multicentre, hospital-based, observational study [J ] . Lancet Public Health , 2021 , 6 ( 12 ): e877 - e887 . DOI: 10.1016/S2468-2667(21)00157-2 http://doi.org/10.1016/S2468-2667(21)00157-2

OUDKERK M , LIU S Y , HEUVELMANS M A , et al . Lung cancer LDCT screening and mortality reduction-evidence, pitfalls and future perspectives [J ] . Nat Rev Clin Oncol , 2021 , 18 ( 3 ): 135 - 151 .

MURPHY S J , AUBRY M C , HARRIS F R , et al . Identification of independent primary tumors and intrapulmonary metastases using DNA rearrangements in non-small cell lung cancer [J ] . J Clin Oncol , 2014 , 32 ( 36 ): 4050 - 4058 . DOI: 10.1200/JCO.2014.56.7644 http://doi.org/10.1200/JCO.2014.56.7644 https://ascopubs.org/doi/10.1200/JCO.2014.56.7644 https://ascopubs.org/doi/10.1200/JCO.2014.56.7644

CHANG Y L , WU C T , LIN S C , et al . Clonality and prognostic implications of p53 and epidermal growth factor receptor somatic aberrations in multiple primary lung cancers [J ] . Clin Cancer Res , 2007 , 13 ( 1 ): 52 - 58 . DOI: 10.1158/1078-0432.CCR-06-1743 http://doi.org/10.1158/1078-0432.CCR-06-1743 https://aacrjournals.org/clincancerres/article/13/1/52/193399/Clonality-and-Prognostic-Implications-of-p53-and https://aacrjournals.org/clincancerres/article/13/1/52/193399/Clonality-and-Prognostic-Implications-of-p53-and

BATTAFARANO R J , MEYERS B F , GUTHRIE T J , et al . Surgical resection of multifocal non-small cell lung cancer is associated with prolonged survival [J ] . Ann Thorac Surg , 2002 , 74 ( 4 ): 988 - 993 ;discussion 993-994. DOI: 10.1016/s0003-4975(02)03878-x http://doi.org/10.1016/s0003-4975(02)03878-x

ZUIN A , ANDRIOLO L G , MARULLI G , et al . Is lobectomy really more effective than sublobar resection in the surgical treatment of second primary lung cancer? [J ] . Eur J Cardiothorac Surg , 2013 , 44 ( 2 ): e120 - e125 ;discussione125. DOI: 10.1093/ejcts/ezt219 http://doi.org/10.1093/ejcts/ezt219 https://academic.oup.com/ejcts/article-lookup/doi/10.1093/ejcts/ezt219 https://academic.oup.com/ejcts/article-lookup/doi/10.1093/ejcts/ezt219

STELLA F , LUCIANO G , DELL’AMORE A , et al . Pulmonary metastases from NSCLC and MPLC (multiple primary lung cancers): management and outcome in a single centre experience [J ] . Heart Lung Circ , 2016 , 25 ( 2 ): 191 - 195 . DOI: 10.1016/j.hlc.2015.07.016 http://doi.org/10.1016/j.hlc.2015.07.016

MASCALCHI M , COMIN C E , BERTELLI E , et al . Screen-detected multiple primary lung cancers in the ITALUNG trial [J ] . J Thorac Dis , 2018 , 10 ( 2 ): 1058 - 1066 . DOI: 10.21037/jtd.2018.01.95 http://doi.org/10.21037/jtd.2018.01.95

ZHAO L S , LIU C Y , XIE G Y , et al . Multiple primary lung cancers: a new challenge in the era of precision medicine [J ] . Cancer Manag Res , 2020 , 12 : 10361 - 10374 . DOI: 10.2147/CMAR.S268081 http://doi.org/10.2147/CMAR.S268081

BOYLE J M , TANDBERG D J , CHINO J P , et al . Smoking history predicts for increased risk of second primary lung cancer: a comprehensive analysis [J ] . Cancer , 2015 , 121 ( 4 ): 598 - 604 . DOI: 10.1002/cncr.29095 http://doi.org/10.1002/cncr.29095

HOWINGTON J A , BLUM M G , CHANG A C , et al . Treatment of stage Ⅰ and Ⅱ non-small cell lung cancer: diagnosis and management of lung cancer, 3rd ed: American College of Chest Physicians evidence-based clinical practice guidelines [J ] . Chest , 2013 , 143 ( 5 Suppl ): e278S - e313S . DOI: 10.1378/chest.12-2359 http://doi.org/10.1378/chest.12-2359 https://linkinghub.elsevier.com/retrieve/pii/S001236921662127X https://linkinghub.elsevier.com/retrieve/pii/S001236921662127X

WALLER D A . Surgical management of lung cancer with multiple lesions: implication of the new recommendations of the 8th edition of the TNM classification for lung cancer [J ] . J Thorac Dis , 2018 , 10 ( Suppl 22 ): S2686 - S2691 . DOI: 10.21037/jtd http://doi.org/10.21037/jtd http://jtd.amegroups.com/ http://jtd.amegroups.com/

HAMAJI M , ALI S O , BURT B M . A meta-analysis of resected metachronous second non-small cell lung cancer [J ] . Ann Thorac Surg , 2015 , 99 ( 4 ): 1470 - 1478 . DOI: 10.1016/j.athoracsur.2014.11.033 http://doi.org/10.1016/j.athoracsur.2014.11.033

DALWADI S M , SZEJA S S , BERNICKER E H , et al . Practice patterns and outcomes in elderly stage Ⅰ non-small-cell lung cancer: a 2004 to 2012 SEER analysis [J ] . Clin Lung Cancer , 2018 , 19 ( 2 ): e269 - e276 . DOI: 10.1016/j.cllc.2017.11.004 http://doi.org/10.1016/j.cllc.2017.11.004 https://linkinghub.elsevier.com/retrieve/pii/S1525730417303169 https://linkinghub.elsevier.com/retrieve/pii/S1525730417303169

DETTERBECK F C , BOFFA D J , KIM A W , et al . The Eighth Edition Lung Cancer Stage Classification [J ] . Chest , 2017 , 151 ( 1 ): 193 - 203 . DOI: S0012-3692(16)60780-8 http://doi.org/S0012-3692(16)60780-8

VIDETIC G M , PAULUS R , SINGH A K , et al . Long-term follow-up on NRG oncology RTOG 0915 (NCCTG N0927): a randomized phase 2 study comparing 2 stereotactic body radiation therapy schedules for medically inoperable patients with stage Ⅰ peripheral non-small cell lung cancer [J ] . Int J Radiat Oncol Biol Phys , 2019 , 103 ( 5 ): 1077 - 1084 . DOI: 10.1016/j.ijrobp.2018.11.051 http://doi.org/10.1016/j.ijrobp.2018.11.051 https://linkinghub.elsevier.com/retrieve/pii/S0360301618340483 https://linkinghub.elsevier.com/retrieve/pii/S0360301618340483

CHI A , WEN S J , LIAO Z X , et al . What would be the most appropriate α/β ratio in the setting of stereotactic body radiation therapy for early stage non-small cell lung cancer [J ] . Biomed Res Int , 2013 , 2013 : 391021 .

Department of Health and Human Services . Common Terminology Criteria for Adverse Events (CTCAE) version 5.0 [R ] . Bethesda: NIH , 2017 .

SHIN J Y , YOON J K , MARWAHA G . Progress in the treatment and outcomes for early-stage non-small cell lung cancer [J ] . Lung , 2018 , 196 ( 3 ): 351 - 358 . DOI: 10.1007/s00408-018-0110-1 http://doi.org/10.1007/s00408-018-0110-1

TURNER K , BROWNSTEIN N C , THOMPSON Z , et al . Longitudinal patient-reported outcomes and survival among early-stage non-small cell lung cancer patients receiving stereotactic body radiotherapy [J ] . Radiother Oncol , 2022 , 167 : 116 - 121 . DOI: 10.1016/j.radonc.2021.12.021 http://doi.org/10.1016/j.radonc.2021.12.021 https://linkinghub.elsevier.com/retrieve/pii/S0167814021090691 https://linkinghub.elsevier.com/retrieve/pii/S0167814021090691

GULSTENE S , RUWANPURA T , PALMA D , et al . Stereotactic ablative radiotherapy in the treatment of early-stage lung cancer-A done deal? [J ] . Clin Oncol (R Coll Radiol) , 2022 , 34 ( 11 ): 733 - 740 . DOI: 10.1016/j.clon.2022.08.027 http://doi.org/10.1016/j.clon.2022.08.027 https://linkinghub.elsevier.com/retrieve/pii/S0936655522003727 https://linkinghub.elsevier.com/retrieve/pii/S0936655522003727

CHANG J Y , SENAN S , PAUL M A , et al . Stereotactic ablative radiotherapy versus lobectomy for operable stage Ⅰ non-small-cell lung cancer: a pooled analysis of two randomised trials [J ] . Lancet Oncol , 2015 , 16 ( 6 ): 630 - 637 . DOI: 10.1016/S1470-2045(15)70168-3 http://doi.org/10.1016/S1470-2045(15)70168-3 https://linkinghub.elsevier.com/retrieve/pii/S1470204515701683 https://linkinghub.elsevier.com/retrieve/pii/S1470204515701683

RAJU S C , PETERS G W , DECKER R H , et al . Clinical outcomes and safety profile in the treatment of synchronous nonmetastatic lung tumors with stereotactic body radiation therapy [J ] . Pract Radiat Oncol , 2022 , 12 ( 2 ): e110 -e116. DOI: 10.1016/j.prro.2021.11.006 http://doi.org/10.1016/j.prro.2021.11.006 https://linkinghub.elsevier.com/retrieve/pii/S1879850021003349 https://linkinghub.elsevier.com/retrieve/pii/S1879850021003349

STEBER C R , HUGHES R T , SOIKE M H , et al . Stereotactic body radiotherapy for synchronous early stage non-small cell lung cancer [J ] . Acta Oncol , 2021 , 60 ( 5 ): 605 - 612 . DOI: 10.1080/0284186X.2021.1892182 http://doi.org/10.1080/0284186X.2021.1892182 https://www.tandfonline.com/doi/full/10.1080/0284186X.2021.1892182 https://www.tandfonline.com/doi/full/10.1080/0284186X.2021.1892182

NIKITAS J , DEWEES T , REHMAN S , et al . Stereotactic body radiotherapy for early-stage multiple primary lung cancers [J ] . Clin Lung Cancer , 2019 , 20 ( 2 ): 107 - 116 . DOI: S1525-7304(18)30294-8 http://doi.org/S1525-7304(18)30294-8

VERSTEGEN N E , LAGERWAARD F J , HASHEMI S M , et al . Patterns of disease recurrence after SABR for early stage non-small-cell lung cancer: optimizing follow-up schedules for salvage therapy [J ] . J Thorac Oncol , 2015 , 10 ( 8 ): 1195 - 1200 . DOI: 10.1097/JTO.0000000000000576 http://doi.org/10.1097/JTO.0000000000000576

MIYAZAKI T , YAMAZAKI T , SATO S , et al . Surgery or stereotactic body radiotherapy for metachronous primary lung cancer? a propensity score matching analysis [J ] . Gen Thorac Cardiovasc Surg , 2020 , 68 ( 11 ): 1305 - 1311 . DOI: 10.1007/s11748-020-01394-3 http://doi.org/10.1007/s11748-020-01394-3

浏览量

2772

下载量

CSCD

文章被引用时，请邮件提醒。

提交

工具集

关联资源

SMARCA4缺失型肺恶性肿瘤的临床病理学特征及患者预后分析

87例唾液腺导管癌患者的治疗策略与预后分析：一项回顾性队列研究

放射性淋巴细胞减少对局限期小细胞肺癌患者预后的影响：一项队列研究

肢端型黑色素瘤组织中MITF的表达及其与临床、病理学特征及预后的相关性研究

PTEN靶向PDK1调控肾透明细胞癌恶性生物学表型的作用机制研究