Ashworth Allison B, Senan Suresh, Palma David A, Riquet Marc, Ahn Yong Chan, Ricardi Umberto, Congedo Maria T, Gomez Daniel R, Wright Gavin M, Melloni Giulio, Milano Michael T, Sole Claudio V, De Pas Tommaso M, Carter Dennis L, Warner Andrew J, Rodrigues George B
Department of Radiation Oncology, London Health Sciences Centre, London, Ontario, Canada.
Department of Radiation Oncology, VU University Medical Center, Amsterdam, Netherlands.
Clin Lung Cancer. 2014 Sep;15(5):346-55. doi: 10.1016/j.cllc.2014.04.003. Epub 2014 May 15.
INTRODUCTION/BACKGROUND: An individual patient data metaanalysis was performed to determine clinical outcomes, and to propose a risk stratification system, related to the comprehensive treatment of patients with oligometastatic NSCLC.
After a systematic review of the literature, data were obtained on 757 NSCLC patients with 1 to 5 synchronous or metachronous metastases treated with surgical metastectomy, stereotactic radiotherapy/radiosurgery, or radical external-beam radiotherapy, and curative treatment of the primary lung cancer, from hospitals worldwide. Factors predictive of overall survival (OS) and progression-free survival were evaluated using Cox regression. Risk groups were defined using recursive partitioning analysis (RPA). Analyses were conducted on training and validating sets (two-thirds and one-third of patients, respectively).
Median OS was 26 months, 1-year OS 70.2%, and 5-year OS 29.4%. Surgery was the most commonly used treatment for the primary tumor (635 patients [83.9%]) and metastases (339 patients [62.3%]). Factors predictive of OS were: synchronous versus metachronous metastases (P < .001), N-stage (P = .002), and adenocarcinoma histology (P = .036); the model remained predictive in the validation set (c-statistic = 0.682). In RPA, 3 risk groups were identified: low-risk, metachronous metastases (5-year OS, 47.8%); intermediate risk, synchronous metastases and N0 disease (5-year OS, 36.2%); and high risk, synchronous metastases and N1/N2 disease (5-year OS, 13.8%).
Significant OS differences were observed in oligometastatic patients stratified according to type of metastatic presentation, and N status. Long-term survival is common in selected patients with metachronous oligometastases. We propose this risk classification scheme be used in guiding selection of patients for clinical trials of ablative treatment.
引言/背景：开展了一项个体患者数据荟萃分析，以确定与寡转移性非小细胞肺癌（NSCLC）患者综合治疗相关的临床结局，并提出一种风险分层系统。
在对文献进行系统回顾后，从全球各医院获取了757例患有1至5个同步或异时转移灶的NSCLC患者的数据，这些患者接受了手术切除转移灶、立体定向放疗/放射外科治疗或根治性外照射放疗，以及原发性肺癌的根治性治疗。使用Cox回归评估总生存期（OS）和无进展生存期的预测因素。使用递归分割分析（RPA）定义风险组。在训练集和验证集（分别为患者的三分之二和三分之一）上进行分析。
中位OS为26个月，1年OS为70.2%，5年OS为29.4%。手术是原发性肿瘤（635例患者[83.9%]）和转移灶（339例患者[62.3%]）最常用的治疗方法。OS的预测因素为：同步转移与异时转移（P <.001）、N分期（P =.002）和腺癌组织学类型（P =.036）；该模型在验证集中仍具有预测性（c统计量 = 0.682）。在RPA中，确定了3个风险组：低风险，异时转移（5年OS，47.8%）；中风险，同步转移且N0期疾病（5年OS，36.2%）；高风险，同步转移且N1/N2期疾病（5年OS，13.8%）。
根据转移表现类型和N状态分层的寡转移性患者中观察到了显著不同的OS。在选定的异时寡转移患者中，长期生存很常见。我们建议使用这种风险分类方案来指导选择患者进行消融治疗的临床试验。
