Leeman Jonathan E, Rimner Andreas, Montecalvo Joseph, Hsu Meier, Zhang Zhigang, von Reibnitz Donata, Panchoo Kelly, Yorke Ellen, Adusumilli Prasad S, Travis William, Wu Abraham J
Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, New York.
Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, New York.
Int J Radiat Oncol Biol Phys. 2017 Jan 1;97(1):138-145. doi: 10.1016/j.ijrobp.2016.09.037. Epub 2016 Sep 29.
Stereotactic body radiation therapy (SBRT) has emerged as an effective treatment for early-stage lung cancer. The histologic subtype of surgically resected lung adenocarcinoma is recognized as a prognostic factor, with the presence of solid or micropapillary patterns predicting poor outcomes. We describe the outcomes after SBRT for early-stage lung adenocarcinoma stratified by histologic subtype.
We identified 119 consecutive patients (124 lesions) with stage I to IIA lung adenocarcinoma who had undergone definitive SBRT at our institution from August 2008 to August 2015 and had undergone core biopsy. Histologic subtyping was performed according to the 2015 World Health Organization classification. Of the 124 tumors, 37 (30%) were a high-risk subtype, defined as containing a component of solid and/or micropapillary pattern. The cumulative incidences of local, nodal, regional, and distant failure were compared between the high-risk and non-high-risk adenocarcinoma subtypes using Gray's test, and multivariable-adjusted hazard ratios (HRs) were estimated from propensity score-weighted Cox regression models.
The median follow-up for the entire cohort was 17 months and for surviving patients was 21 months. The 1-year cumulative incidence of and adjusted HR for local, nodal, regional, and distant failure in high-risk versus non-high-risk lesions was 7.3% versus 2.7% (HR 16.8; 95% confidence interval [CI] 3.5-81.4), 14.8% versus 2.6% (HR 3.8; 95% CI 0.95-15.0), 4.0% versus 1.2% (HR 20.9; 95% CI 2.3-192.3), and 22.7% versus 3.6% (HR 6.9; 95% CI 2.2-21.1), respectively. No significant difference was seen with regard to overall survival.
The outcomes after SBRT for early-stage adenocarcinoma of the lung correlate highly with histologic subtype, with micropapillary and solid tumors portending significantly higher rates of locoregional and metastatic progression. In this context, the histologic subtype determined from core biopsies is a prognostic factor and could have important implications for patient selection, adjuvant treatment, biopsy methods, and clinical trial design.
立体定向体部放射治疗（SBRT）已成为早期肺癌的一种有效治疗方法。手术切除的肺腺癌组织学亚型被认为是一个预后因素，实性或微乳头样结构的存在预示着不良预后。我们描述了根据组织学亚型分层的早期肺腺癌患者接受SBRT后的治疗结果。
我们确定了119例连续的I至IIA期肺腺癌患者（124个病灶），这些患者于2008年8月至2015年8月在我们机构接受了根治性SBRT，并接受了芯针活检。根据2015年世界卫生组织分类进行组织学亚型分型。在这124个肿瘤中，37个（30%）为高危亚型，定义为含有实性和/或微乳头样结构成分。使用Gray检验比较高危和非高危腺癌亚型之间局部、淋巴结、区域和远处失败的累积发生率，并从倾向评分加权的Cox回归模型估计多变量调整风险比（HRs）。
整个队列的中位随访时间为17个月，存活患者为21个月。高危与非高危病灶局部、淋巴结、区域和远处失败的1年累积发生率及调整后HR分别为7.3%对2.7%（HR 16.8；95%置信区间[CI] 3.5 - 81.4）、14.8%对2.6%（HR 3.8；95% CI 0.95 - 15.0）、4.0%对1.2%（HR 20.9；95% CI 2.3 - 192.3）和22.7%对3.6%（HR 6.9；95% CI 2.2 - 21.1）。总生存期方面未见显著差异。
早期肺腺癌患者接受SBRT后的治疗结果与组织学亚型高度相关，微乳头样和实性肿瘤的局部区域和转移进展率显著更高。在此背景下，通过芯针活检确定的组织学亚型是一个预后因素，可能对患者选择、辅助治疗、活检方法和临床试验设计具有重要意义。
