Nieder Carsten, Tollåli Terje, Haukland Ellinor, Reigstad Anne, Flatøy Liv Randi, Dalhaug Astrid
Department of Oncology and Palliative Medicine, Nordland Hospital Trust, Bodø, Norway; Department of Clinical Medicine, Faculty of Health Sciences, University of Tromsø, Tromsø, Norway.
Department of Pulmonology, Nordland Hospital Trust, Bodø, Norway.
Clin Lung Cancer. 2017 Jul;18(4):e297-e301. doi: 10.1016/j.cllc.2017.01.006. Epub 2017 Jan 19.
Palliative thoracic radiotherapy is a common treatment for patients with incurable lung cancer. A recent study suggested that a prognostic score based on performance status and N and M stage predicts survival and might support decision-making (eg, when deciding about fractionation). Our aim was to perform a validation study in an independent, larger dataset.
This was a retrospective single-institution study of 232 patients with small- or non-small-cell lung cancer, with methodology comparable with that of the original study. Three subgroups were created, based on the point sum resulting from assessment of performance status and N and M stage (10-11, 12-14, 15-17 points).
Performance status and N and M stage were significantly associated with overall survival after palliative radiotherapy in uni- and multivariate analyses. An unfavorable prognosis (10-11 points) was predicted in 56 patients (24%). Their median survival was 1.2 months. The intermediate group consisted of 137 patients (59%) with a median survival of 5.3 months. A favorable prognosis (15-17 points) was predicted in 39 patients (17%), whose median survival was 8.2 months. The difference between the intermediate and favorable subgroups did not reach statistical significance (P = .1, as compared with P = .0001 for the remaining 2 comparisons).
In the original study, the median survival of patients in the 3 different prognostic strata was 2, 6, and 38 months. Except for the favorable subgroup, the validation study confirmed these results. Given the large, clinically highly relevant discrepancy (8 vs. 38 months), additional studies are needed in order to inform therapeutic decisions in patients with favorable point sum of 15 to 17.
姑息性胸部放疗是不可治愈肺癌患者的常见治疗方法。最近一项研究表明，基于体能状态以及N和M分期的预后评分可预测生存率，并可能有助于决策制定（例如，在决定分割方式时）。我们的目的是在一个独立的更大数据集中进行验证研究。
这是一项对232例小细胞或非小细胞肺癌患者进行的回顾性单机构研究，其方法与原研究类似。根据体能状态以及N和M分期评估得出的总分（10 - 11分、12 - 14分、15 - 17分）创建了三个亚组。
在单因素和多因素分析中，体能状态以及N和M分期与姑息性放疗后的总生存期显著相关。56例患者（24%）被预测预后不良（10 - 11分）。他们的中位生存期为1.2个月。中间组由137例患者（59%）组成，中位生存期为5.3个月。39例患者（17%）被预测预后良好（15 - 17分），其中位生存期为8.2个月。中间亚组和良好亚组之间的差异未达到统计学意义（P = 0.1，其余两组比较P = 0.0001）。
在原研究中，三个不同预后分层患者的中位生存期分别为2个月、6个月和38个月。除了良好亚组外，验证研究证实了这些结果。鉴于存在较大的、临床高度相关的差异（8个月与38个月），需要进行更多研究以便为总分15至17分的预后良好患者的治疗决策提供依据。
