Wu Abraham J, Gillis Andrea, Foster Amanda, Woo Kaitlin, Zhang Zhigang, Gelblum Daphna Y, Downey Robert J, Rosenzweig Kenneth E, Ong Leonard, Perez Carmen A, Pietanza M Catherine, Krug Lee, Rudin Charles M, Rimner Andreas
Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, United States.
Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, United States.
Radiother Oncol. 2017 Oct;125(1):130-135. doi: 10.1016/j.radonc.2017.07.019. Epub 2017 Aug 1.
The relationship between tumor-node-metastasis (TNM) stage and patterns of failure in limited-stage small cell lung cancer (LS-SCLC) remains unclear. We hypothesized that TNM stage predicts brain metastasis risk, and could inform the use of prophylactic cranial irradiation.
We reviewed 283 patients with stage I-IIIB SCLC. Competing-risks regression was used to analyze local, distant, and brain failure. Multivariate analysis was used to evaluate the effect of treatment and clinical factors on failure and OS.
Patients with stage I or II SCLC (35% of cohort) had significantly better survival and lower risk of distant and brain metastasis, compared with stage III patients. The 5-year cumulative incidence of brain metastasis for stage I/II and III were 12% and 26%, respectively. Stage had no correlation with local failure. On multivariate analysis, stage was independently prognostic for survival, distant metastasis risk, and brain metastasis risk.
TNM staging predicts likelihood of distant metastasis, brain metastasis, and survival in LS-SCLC. This supports the routine use of TNM staging in clinical practice. The lower risk of brain metastasis in stage I and II SCLC suggests that prophylactic cranial irradiation could play a more limited role in treatment of early-stage disease.
局限期小细胞肺癌（LS-SCLC）中肿瘤-淋巴结-转移（TNM）分期与失败模式之间的关系仍不明确。我们假设TNM分期可预测脑转移风险，并可为预防性颅脑照射的应用提供依据。
我们回顾了283例I-IIIB期小细胞肺癌患者。采用竞争风险回归分析局部、远处和脑转移失败情况。多因素分析用于评估治疗和临床因素对失败和总生存期（OS）的影响。
与III期患者相比，I期或II期小细胞肺癌患者（占队列的35%）的生存期显著更长，远处和脑转移风险更低。I/II期和III期脑转移的5年累积发生率分别为12%和26%。分期与局部失败无关。多因素分析显示，分期对生存期、远处转移风险和脑转移风险具有独立的预后价值。
TNM分期可预测LS-SCLC远处转移、脑转移的可能性及生存期。这支持在临床实践中常规使用TNM分期。I期和II期小细胞肺癌脑转移风险较低，提示预防性颅脑照射在早期疾病治疗中的作用可能更为有限。
