Park Henry S, Decker Roy H, Wilson Lynn D, Yu James B
Department of Therapeutic Radiology, Yale University School of Medicine, New Haven, CT.
Department of Therapeutic Radiology, Yale University School of Medicine, New Haven, CT.
Clin Lung Cancer. 2015 Jul;16(4):292-7. doi: 10.1016/j.cllc.2014.11.005. Epub 2014 Nov 22.
Although there is no proven survival benefit of prophylactic cranial irradiation (PCI) for patients with locally advanced (LA) non-small-cell lung cancer (NSCLC), some speculate that PCI might be helpful for certain subpopulations at higher risk of brain metastases (< 60 years, adenocarcinoma, or stage IIIB). In this study we evaluated the effect of PCI on survival among these high-risk LA-NSCLC patients on a national scale.
Using the Surveillance, Epidemiology, and End Results database, we included all adult patients with primary stage III NSCLC, diagnosed from 1988 to 1997 (years during which PCI was recorded) with follow-up until 2008. The Kaplan-Meier estimator, log-rank test, and Cox proportional hazard regression were used to evaluate the survival effect of PCI. Sequential landmark analysis excluding patients from 1 to 6 months after diagnosis was used to account for immortal time bias.
A total of 17,852 patients were included in the analysis, among whom 326 (1.8%) received PCI. Patients younger than 60 years and those with adenocarcinoma were significantly more likely to receive PCI. After adjustment for available covariates, there was no statistically significant survival difference between PCI and non-PCI patients (hazard ratio, 1.04; 95% confidence interval, 0.93-1.16). Similar results were found in all subgroup analyses of high-risk patients. Sequential landmark analysis suggested a potential survival detriment associated with PCI when analyzing only patients who survived at least 3 months after diagnosis.
Our population-based analysis suggested no overall survival benefit of PCI for LA-NSCLC patients, even among a group of patients who were at higher risk for brain metastases.
尽管对于局部晚期（LA）非小细胞肺癌（NSCLC）患者，预防性颅脑照射（PCI）尚未被证实具有生存获益，但一些人推测PCI可能对某些脑转移风险较高的亚组患者（年龄<60岁、腺癌或IIIB期）有益。在本研究中，我们在全国范围内评估了PCI对这些高危LA-NSCLC患者生存的影响。
使用监测、流行病学和最终结果数据库，我们纳入了所有1988年至1997年（记录了PCI的年份）诊断为原发性III期NSCLC的成年患者，并随访至2008年。采用Kaplan-Meier估计法、对数秩检验和Cox比例风险回归来评估PCI的生存效果。采用排除诊断后1至6个月患者的序贯标志性分析来处理不朽时间偏倚。
共有17,852例患者纳入分析，其中326例（1.8%）接受了PCI。年龄小于60岁的患者和腺癌患者接受PCI的可能性显著更高。在对可用协变量进行调整后，PCI患者和未接受PCI患者之间在生存方面无统计学显著差异（风险比，1.04；95%置信区间，0.93 - 1.16）。在所有高危患者亚组分析中均发现了类似结果。序贯标志性分析表明，仅分析诊断后至少存活3个月的患者时，PCI可能与生存损害相关。
我们基于人群的分析表明，PCI对LA-NSCLC患者无总体生存获益，即使在脑转移风险较高的一组患者中也是如此。
