Sundstrøm Stein, Bremnes Roy M, Brunsvig Paal, Aasebø Ulf, Kaasa Stein
Department of Oncology, St. Olavs Hospital, University Hospital of Trondheim, Norway.
J Thorac Oncol. 2006 Oct;1(8):816-24.
Patient-assessed health-related quality-of-life (HRQOL) scores, together with demographic and clinical factors in stage III non-small cell lung cancer (NSCLC) patients, are important prognostic factors for survival and may be helpful in determining thoracic radiotherapy (TRT) strategy.
In a previously published randomized trial, 301 patients were treated with different palliative radiotherapy schedules, comparing short-term hypofractionated TRT (arm A: 17 Gy/2 fractions [n = 105]) with more protracted TRT (arm B: 42 Gy/15 fractions [n = 104]); arm C: 50 Gy/25 fractions [n = 92]). Baseline HRQOL, demographic, and clinical data were available for all patients. All possible prognostic factors from univariate analysis were entered into the Cox multivariate regression model to identify variables of independent prognostic relevance.
Overall survival was similar, whereas long-term survival was restricted to higher-dose radiotherapy with 3-year survival rates of 1, 8, and 6% (p = 0.40) and 5-year survival rates of 0, 4, and 3% (p = 0.12) in arms A, B, and C, respectively. In univariate analysis, Karnofsky performance status, use of analgesics, and weight loss were highly significant non-HRQOL factors (p < 0.001), and physical function, appetite loss, cough, and pain were the most powerful HRQOL factors (p < 0.001). In multivariate analysis, appetite loss appeared as the most powerful independent prognostic indicator. In the group of patients treated with protracted fractionation (n = 196), the 2-, 3-, and 5-year survival rates in patients with no appetite loss (n = 95) were 22% (21/95), 12% (11/95), and 8% (8/95) compared with 3% (3/101), 1% (1/101), and 1% (1/101) in patients with appetite loss present at baseline (n = 101).
In addition to performance status and weight loss, patient-reported appetite loss should be assessed in stage III NSCLC patients before administrating TRT; such assessment is a valuable tool for selecting patients to normofractionated or lower-dose hypofractionated palliative TRT.
患者评估的健康相关生活质量（HRQOL）评分，以及Ⅲ期非小细胞肺癌（NSCLC）患者的人口统计学和临床因素，是生存的重要预后因素，可能有助于确定胸部放疗（TRT）策略。
在一项先前发表的随机试验中，301例患者接受了不同的姑息性放疗方案，将短期大分割TRT（A组：17 Gy/2次分割[n = 105]）与更延长疗程的TRT（B组：42 Gy/15次分割[n = 104]）进行比较；C组：50 Gy/25次分割[n = 92]）。所有患者均有基线HRQOL、人口统计学和临床数据。将单因素分析中所有可能的预后因素纳入Cox多因素回归模型，以确定具有独立预后相关性的变量。
总生存率相似，而长期生存仅限于高剂量放疗，A、B和C组的3年生存率分别为1%、8%和6%（p = 0.40），5年生存率分别为0%、4%和3%（p = 0.12）。在单因素分析中，卡诺夫斯基功能状态、镇痛药的使用和体重减轻是高度显著的非HRQOL因素（p < 0.001），身体功能、食欲减退、咳嗽和疼痛是最有力的HRQOL因素（p < 0.001）。在多因素分析中，食欲减退是最有力的独立预后指标。在接受延长分割治疗的患者组（n = 196）中，无食欲减退患者（n = 95）的2年、3年和5年生存率分别为22%（21/95）、12%（11/95）和8%（8/95），而基线时有食欲减退的患者（n = 101）的生存率分别为3%（3/101）、1%（1/101）和1%（1/101）。
除了功能状态和体重减轻外，在对Ⅲ期NSCLC患者进行TRT之前，应评估患者报告的食欲减退情况；这种评估是选择患者进行常规分割或低剂量大分割姑息性TRT的有价值工具。
