Huang Eugene H, Liao Zhongxing, Cox James D, Guerrero Thomas M, Chang Joe Y, Jeter Melinda, Borghero Yerko, Wei Xiong, Fossella Frank, Herbst Roy S, Blumenschein George R, Moran Cesar, Allen Pamela K, Komaki Ritsuko
Department of Radiation Oncology, The University of Texas M. D. Anderson Cancer Center, Houston, TX 77030, USA.
Int J Radiat Oncol Biol Phys. 2007 Jul 1;68(3):779-85. doi: 10.1016/j.ijrobp.2007.01.002. Epub 2007 Apr 6.
To retrospectively compare outcomes for patients with unresectable locally advanced non-small-cell lung cancer (NSCLC) treated at our institution with concurrent chemoradiation with or without induction chemotherapy.
We retrospectively analyzed 265 consecutive patients who received definitive treatment with three-dimensional conformal radiation and concurrent chemotherapy. Of these, 127 patients received induction chemotherapy before concurrent chemoradiation.
The two groups of patients (with induction vs. without induction chemotherapy) were similar in age, performance status, weight loss, histology, grade, and stage. Patients who received induction chemotherapy had better overall survival (median, 1.9 vs. 1.4 years; 5-year rate, 25% vs. 12%; p < 0.001) and distant metastasis-free survival (5-year rate, 42% vs. 23%; p = 0.021). Locoregional control was not significantly different between the two groups. Multivariate analysis showed that induction chemotherapy was the most significant factor affecting overall survival, with a hazard ratio of 0.55 (95% confidence interval 0.40-0.75; p < 0.001). A planned subgroup analysis showed that induction chemotherapy was associated with a significant overall survival benefit for patients with adenocarcinoma or large-cell carcinoma (5-year rate, 24% vs. 8%; p = 0.003) but not for those with squamous cell carcinoma. A multivariate analysis of patients with adenocarcinoma or large-cell carcinoma confirmed that induction chemotherapy was the most significant factor associated with better overall survival, with a hazard ratio of 0.47 (95% confidence interval, 0.28-0.78; p = 0.003).
Our retrospective analysis suggests that in combination with concurrent chemoradiation, induction chemotherapy may provide a small but significant survival benefit for patients with unresectable locally advanced adenocarcinoma or large-cell carcinoma of the lung.
回顾性比较在我院接受同步放化疗且接受或未接受诱导化疗的不可切除局部晚期非小细胞肺癌（NSCLC）患者的治疗结果。
我们回顾性分析了265例接受三维适形放疗和同步化疗的确定性治疗的连续患者。其中，127例患者在同步放化疗前接受了诱导化疗。
两组患者（接受诱导化疗与未接受诱导化疗）在年龄、体能状态、体重减轻、组织学、分级和分期方面相似。接受诱导化疗的患者总生存期更好（中位数，1.9年对1.4年；5年生存率，25%对12%；p<0.001），远处无转移生存期也更好（5年生存率，42%对23%；p=0.021）。两组间局部区域控制无显著差异。多因素分析显示诱导化疗是影响总生存期的最显著因素，风险比为0.55（95%置信区间0.40-0.75；p<0.001）。一项计划中的亚组分析显示，诱导化疗对腺癌或大细胞癌患者有显著的总生存期获益（5年生存率，24%对8%；p=0.003），但对鳞状细胞癌患者无此获益。对腺癌或大细胞癌患者的多因素分析证实，诱导化疗是与更好的总生存期相关的最显著因素，风险比为0.47（95%置信区间，0.28-0.78；p=0.003）。
我们的回顾性分析表明，与同步放化疗联合使用时，诱导化疗可能为不可切除的局部晚期肺腺癌或大细胞癌患者提供虽小但显著的生存获益。
