Division of Radiation Oncology and Cancer Imaging, Peter MacCallum Cancer Centre, East Melbourne, VIC 8006, Australia.
J Thorac Oncol. 2013 Mar;8(3):315-21. doi: 10.1097/JTO.0b013e31827dc74d.
Analysis of the International Association for the Study of Lung Cancer database revealed that for patients with completely resected, node-negative, non-small-cell lung cancer (NSCLC), increasing tumor size was associated with worsening survival. This analysis was performed to determine the effect of size on prognosis in patients in the same database but who were treated with radiotherapy or chemoradiotherapy.
Patients were eligible if they had pathologically confirmed NSCLC, no evidence of distant metastases, intended treatment was radical radiotherapy (minimum 50 Gy) or combined chemotherapy and radiotherapy, no surgery, and tumor diameter was available.
Eight hundred and sixty-eight patients were available for analysis. Patient characteristics were: sex (men) 65.3%; median age 64 years (range, 32-88); Eastern Cooperative Oncology Group performance status 0: 55%, 1: 33%, 2 or more: 5%; chemotherapy 74%; no chemotherapy 18%; weight loss less than 5 %: 70%, and more than 5%: 25%. Primary tumor size was categorized according to tumor, node, metastasis 7th edition. On univariate analysis, the following factors were prognostic for survival: age (continuous) (p = 0.0035); performance status of 1 or more (p = 0.0021); weight loss less than 5% (p < 0.0001); chemotherapy (p = 0.0189); and primary tumor size (continuous) (p = 0.0002). Sex and clinical nodal stage were not significant. On multivariate analysis, age and weight loss remained significant factors for survival, as was tumor size less than 3 cm.
In patients treated with radiotherapy with or without chemotherapy, tumor size less than 3 cm was associated with longer survival than larger tumors. Evidence of the effect of size on prognosis above this was weak. Five-year survival of more than 10% was observed in all four size categories.
对国际肺癌研究协会数据库的分析显示，对于完全切除、淋巴结阴性、非小细胞肺癌（NSCLC）患者，肿瘤大小的增加与生存状况恶化相关。本分析旨在确定同一数据库中接受放疗或放化疗治疗的患者中，肿瘤大小对预后的影响。
符合条件的患者需满足以下条件：病理证实为 NSCLC，无远处转移证据，计划接受根治性放疗（最低 50Gy）或联合化疗和放疗，未接受手术，且肿瘤直径可测量。
868 例患者可用于分析。患者特征为：性别（男）65.3%；中位年龄 64 岁（范围，32-88 岁）；东部肿瘤协作组体能状态 0 分：55%，1 分：33%，2 分或以上：5%；化疗 74%；未化疗 18%；体重减轻小于 5%：70%，大于 5%：25%。根据肿瘤、淋巴结、转移第 7 版将原发肿瘤大小分类。单因素分析显示，以下因素与生存相关：年龄（连续）（p=0.0035）；体能状态 1 分或以上（p=0.0021）；体重减轻小于 5%（p<0.0001）；化疗（p=0.0189）；以及原发肿瘤大小（连续）（p=0.0002）。性别和临床淋巴结分期无统计学意义。多因素分析显示，年龄和体重减轻仍是生存的重要因素，肿瘤大小小于 3cm 也是如此。
在接受放疗联合或不联合化疗的患者中，肿瘤小于 3cm 与较长的生存时间相关，而肿瘤大小大于 3cm 与预后相关的证据较弱。在所有四个肿瘤大小类别中，都观察到 5 年生存率超过 10%。
