Manapov Farkhad, Niyazi Maximilian, Gerum Sabine, Roengvoraphoj Olarn, Eze Chukwuka, Li Minglun, Hildebrandt Guido, Fietkau Rainer, Klautke Gunther, Belka Claus
Radiation Oncology, Ludwig-Maximilian University Munich, Marchioninistrasse 15, 81377, Munich, Germany.
Radiation Oncology, University of Rostock, Südring 75, 18059, Rostock, Germany.
BMC Cancer. 2016 Mar 14;16:216. doi: 10.1186/s12885-016-2245-x.
The role of remission status in limited disease (LD) small-cell lung cancer (SCLC) patients treated with definitive chemoradiotherapy (CRT) remains to be finally clarified.
Individual data from 184 patients treated with definitive CRT concurrently or sequentially were retrospectively reviewed. Kaplan-Meier analysis as well as univariate and multivariate Cox regression models were used to describe survival within patient subgroups defined by remission status.
71 (39%) patients were treated in the concurrent, 113 (61%) in the sequential CRT mode. Prophylactic cranial irradiation (PCI) was applied in 71 (39%) patients. 37 (20%) patients developed local, while 89 (48%) distant recurrence. 58 (32%) patients developed metachronous brain metastases. Complete, partial remission and non-response (defined as stable and progressive disease) were documented in 65 (35%), 77 (42%), and 37 (20%) patients, respectively. In complete responders median overall survival was 21.8 months (95CI: 18.6 - 25) versus 14.9 (95% CI: 11.7 - 18.2) (p = 0.041, log-rank test) and 11.5 months (95% CI: 8.9 - 15.0) (p < 0.001, log-rank test) in partial and non-responders, respectively. The same effect was documented for the time to progression and distant metastasis-free survival. In the multivariate analysis achievement of complete remission as a variable shows a trend for the prolonged time to progression (p = 0.1, HR 1.48) and distant metastasis-free survival (p = 0.06, HR 1.63) compared to partial responders and was highly significant compared to non-responders.
In this treated heterogeneous LD SCLC patient cohort complete remission was associated with longer time to progression, distant metastasis-free and overall survival compared to the non- and especially partial responders.
在接受根治性放化疗（CRT）的局限性疾病（LD）小细胞肺癌（SCLC）患者中，缓解状态的作用仍有待最终明确。
回顾性分析了184例接受同步或序贯根治性CRT治疗患者的个体数据。采用Kaplan-Meier分析以及单因素和多因素Cox回归模型来描述由缓解状态定义的患者亚组的生存情况。
71例（39%）患者接受同步CRT治疗，113例（61%）接受序贯CRT治疗。71例（39%）患者接受了预防性颅脑照射（PCI）。37例（20%）患者发生局部复发，89例（48%）发生远处复发。58例（32%）患者发生异时性脑转移。完全缓解、部分缓解和无反应（定义为疾病稳定和进展）分别记录在65例（35%）、77例（42%）和37例（20%）患者中。完全缓解者的中位总生存期为21.8个月（95%CI：18.6 - 25），部分缓解者为14.9个月（95%CI：11.7 - 18.2）（p = 0.041，对数秩检验），无反应者为11.5个月（95%CI：8.9 - 15.0）（p < 0.001，对数秩检验）。进展时间和无远处转移生存期也有同样的结果。在多因素分析中，作为变量的完全缓解的实现与部分缓解者相比，进展时间延长（p = 0.1，HR 1.48）和无远处转移生存期延长（p = 0.06，HR 1.63）有趋势，与无反应者相比具有高度显著性。
在这个接受治疗的异质性LD SCLC患者队列中，与无反应者尤其是部分缓解者相比，完全缓解与更长的进展时间、无远处转移生存期和总生存期相关。
