Public Health Nutrition Unit, Technische Universität München, D-85350 Freising, Germany.
Lung Cancer. 2011 Jul;73(1):70-7. doi: 10.1016/j.lungcan.2010.10.017. Epub 2010 Nov 20.
Systemic therapy is the most relevant option for patients with advanced non-small-cell lung cancer (NSCLC) and many receive therapies beyond first-line. Little is known on response, progression free survival (PFS) and overall survival (OS) and their prognostic factors after second- and third-line therapy in daily clinical practice. Between January 2003 and July 2007, 406 consecutive patients were included in this prospective observational study and followed up until August 2010. At each treatment line the timing and kind of therapy, best response achieved, sites and time of progression were documented. Multiple logistic and Cox-regression models were used to analyse prognostic factors for achieving disease control (DC: response or disease stabilization), PFS and OS after different therapy lines. DC rate and median PFS decreased from 64% and 146 days, to 41% and 49 days, and to 39% and 51 days in response to first-, second- and third-line, respectively. A strong predictor for a worse outcome after second-line was development of new metastases after first-line therapy (DC: OR=2.50; 95% CI: 1.30-4.83; p-value=0.006; PFS: HR=1.53; 95% CI: 1.13-2.06; p-value=0.005) or achieving no DC after first-line (OS: HR=1.41; 95% CI: 1.01-1.97; p-value=0.041). Achieving no DC after second-line was a strong negative predictor for all outcome measures after third-line therapy (DC: OR=5.10; 95% CI: 1.56-16.6; p-value=0.007; PFS: HR=2.00; 95% CI: 1.23-3.27; p-value=0.005; OS: HR=1.69; 95% CI: 1.02-2.79; p-value=0.042). In conclusion, response in previous line and no involvement of new metastases after progression were relevant positive prognostic factors. However, further research is necessary to identify optimal therapy sequences.
系统治疗是晚期非小细胞肺癌（NSCLC）患者最相关的选择，许多患者在一线治疗后还接受了多种治疗。在日常临床实践中，二线和三线治疗后的反应、无进展生存期（PFS）和总生存期（OS）及其预后因素知之甚少。2003 年 1 月至 2007 年 7 月，406 例连续患者纳入本前瞻性观察研究，并随访至 2010 年 8 月。在每一线治疗中，记录了治疗的时机和类型、最佳反应、进展部位和时间。采用多变量逻辑回归和 Cox 回归模型分析不同治疗线后实现疾病控制（DC：反应或疾病稳定）、PFS 和 OS 的预后因素。二线治疗后的 DC 率和中位 PFS 分别从 64%和 146 天下降至 41%和 49 天，再下降至 39%和 51 天。一线治疗后发生新转移（DC：OR=2.50；95%CI：1.30-4.83；p 值=0.006；PFS：HR=1.53；95%CI：1.13-2.06；p 值=0.005）或一线治疗后无 DC 为二线治疗后预后较差的强预测因素（OS：HR=1.41；95%CI：1.01-1.97；p 值=0.041）。二线治疗后无 DC 是三线治疗后所有结局的强负预测因素（DC：OR=5.10；95%CI：1.56-16.6；p 值=0.007；PFS：HR=2.00；95%CI：1.23-3.27；p 值=0.005；OS：HR=1.69；95%CI：1.02-2.79；p 值=0.042）。总之，前一线的反应和进展后无新转移是相关的阳性预后因素。然而，需要进一步研究以确定最佳治疗顺序。
