Department of Radiation Oncology, Duke University, Durham, NC, United States of America.
Department of Radiation Oncology, Vanderbilt University, Nashville, TN, United States of America.
PLoS One. 2018 Apr 12;13(4):e0195149. doi: 10.1371/journal.pone.0195149. eCollection 2018.
Radiotherapy is increasingly used to treat oligometastatic patients. We sought to identify prognostic criteria in oligometastatic patients undergoing definitive hypofractionated image-guided radiotherapy (HIGRT).
Exclusively extracranial oligometastatic patients treated with HIGRT were pooled. Characteristics including age, sex, primary tumor type, interval to metastatic diagnosis, number of treated metastases and organs, metastatic site, prior systemic therapy for primary tumor treatment, prior definitive metastasis-directed therapy, and systemic therapy for metastasis associated with overall survival (OS), progression-free survival (PFS), and treated metastasis control (TMC) were assessed by the Cox proportional hazards method. Recursive partitioning analysis (RPA) identified prognostic risk strata for OS and PFS based on pretreatment factors.
361 patients were included. Primary tumors included non-small cell lung (17%), colorectal (19%), and breast cancer (16%). Three-year OS was 56%, PFS was 24%, and TMC was 72%. On multivariate analysis, primary tumor, interval to metastases, treated metastases number, and mediastinal/hilar lymph node, liver, or adrenal metastases were associated with OS. Primary tumor site, involved organ number, liver metastasis, and prior primary disease chemotherapy were associated with PFS. OS RPA identified five classes: class 1: all breast, kidney, or prostate cancer patients (BKP) (3-year OS 75%, 95% CI 66-85%); class 2: patients without BKP with disease-free interval of 75+ months (3-year OS 85%, 95% CI 67-100%); class 3: patients without BKP, shorter disease-free interval, ≤ two metastases, and age < 62 (3-year OS 55%, 95% CI 48-64%); class 4: patients without BKP, shorter disease-free interval, ≥ three metastases, and age < 62 (3-year OS 38%, 95% CI 24-60%); class 5: all others (3-year OS 13%, 95% CI 5-35%). Higher biologically effective dose (BED) (p < 0.01) was associated with OS.
We identified clinical factors defining oligometastatic patients with favorable outcomes, who we hypothesize are most likely to benefit from metastasis-directed therapy.
放射治疗越来越多地用于治疗寡转移患者。我们旨在确定接受根治性低分割图像引导放射治疗（HIGRT）的寡转移患者的预后标准。
仅汇集接受 HIGRT 的颅外寡转移患者。通过 Cox 比例风险方法评估特征，包括年龄、性别、原发肿瘤类型、转移诊断至转移的间隔时间、治疗转移的数量和器官、转移部位、原发性肿瘤治疗的先前系统治疗、先前确定性转移导向治疗以及与总生存（OS）、无进展生存（PFS）和治疗转移控制（TMC）相关的全身治疗。递归分区分析（RPA）根据预处理因素确定 OS 和 PFS 的预后风险分层。
共纳入 361 例患者。原发肿瘤包括非小细胞肺癌（17%）、结直肠癌（19%）和乳腺癌（16%）。3 年 OS 为 56%，PFS 为 24%，TMC 为 72%。多变量分析显示，原发肿瘤、转移至转移的时间间隔、治疗转移的数量以及纵隔/肺门淋巴结、肝或肾上腺转移与 OS 相关。原发肿瘤部位、受累器官数量、肝转移和原发性疾病化疗与 PFS 相关。OS-RPA 确定了五类：第 1 类：所有乳腺癌、肾脏或前列腺癌患者（BKP）（3 年 OS 为 75%，95%CI 为 66-85%）；第 2 类：无 BKP 且疾病无进展间隔时间为 75+个月的患者（3 年 OS 为 85%，95%CI 为 67-100%）；第 3 类：无 BKP、较短疾病无进展间隔时间、≤ 2 个转移灶且年龄<62 岁的患者（3 年 OS 为 55%，95%CI 为 48-64%）；第 4 类：无 BKP、较短疾病无进展间隔时间、≥ 3 个转移灶且年龄<62 岁的患者（3 年 OS 为 38%，95%CI 为 24-60%）；第 5 类：所有其他患者（3 年 OS 为 13%，95%CI 为 5-35%）。较高的生物有效剂量（BED）（p<0.01）与 OS 相关。
我们确定了定义预后良好的寡转移患者的临床因素，我们假设这些患者最有可能从转移导向治疗中受益。
