Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Department of Infectious Diseases and Pulmonary Medicine, Berlin, Germany.
Klinik für Pneumologie - Evangelische Lungenklinik Berlin Buch, Berlin, Germany.
Lung Cancer. 2018 Nov;125:164-173. doi: 10.1016/j.lungcan.2018.09.021. Epub 2018 Sep 25.
Local ablative treatment (LAT) improves outcome in lung cancer with oligometastatic disease (OMD) and potentially leads to long term survival. The aim of this retrospective study was to evaluate and quantify the additional benefit of LAT in synchronous OMD and to further identify prognostic factors for survival.
A propensity score-matched pairs analysis was performed on a set of patient and disease variables in 180 patients, treated for synchronous single organ OMD including non small-cell and neuroendocrine lung cancer with ≤4 metastases between 2000 and 2016 in 3 lung cancer centers in Berlin, Germany. Patients either received LAT for all sites of disease (intervention group) by means of surgery or stereotactic radiotherapy, or standard chemotherapy, if necessary combined with a local treatment with palliative intent (control group).
Median follow-up time was 32.2 and 18.8 months for the intervention and control group, respectively. Substantial benefits in median progression-free survival (PFS, 25.1 vs. 8.2 months; HR, 0.30; 95% CI, 0.21-0.43; p < 0.001) and overall survival (OS, 60.4 vs. 22.5 months; HR, 0.42; 95% CI, 0.28-0.62; p < 0.001) were associated with LAT. Histology of adenocarcinoma and T1a primaries also predicted a favorable prognosis concerning PFS and OS. More favorable nodal stage (N0-2 vs. 3) and solitary metastases were associated with an extended PFS, whereas initial ECOG-PS (0-1 vs. 2) predicted OS.
LAT was the strongest predictor for PFS and OS in OMD with ≤4 metastases. Survival in the control group identifies OMD as a subset of lung cancer with a generally more favorable prognosis.
局部消融治疗（LAT）可改善寡转移疾病（OMD）肺癌的预后，并可能导致长期生存。本回顾性研究旨在评估和量化 LAT 在同步 OMD 中的额外获益，并进一步确定生存的预后因素。
对德国柏林 3 家肺癌中心在 2000 年至 2016 年间治疗的 180 例患有≤4 个转移灶的同步单一器官 OMD（包括非小细胞和神经内分泌肺癌）的患者的一组患者和疾病变量进行了倾向评分匹配对分析。患者要么接受所有病变部位的 LAT（干预组），方法是手术或立体定向放疗，要么接受标准化疗，如果需要，则联合姑息性局部治疗（对照组）。
干预组和对照组的中位随访时间分别为 32.2 和 18.8 个月。干预组在中位无进展生存期（PFS，25.1 个月 vs. 8.2 个月；HR，0.30；95%CI，0.21-0.43；p<0.001）和总生存期（OS，60.4 个月 vs. 22.5 个月；HR，0.42；95%CI，0.28-0.62；p<0.001）方面有明显获益。腺癌组织学和 T1a 期原发性肿瘤也与 PFS 和 OS 预后良好相关。更有利的淋巴结分期（N0-2 期 vs. 3 期）和单一转移与 PFS 延长相关，而初始 ECOG-PS（0-1 期 vs. 2 期）则预测 OS。
LAT 是≤4 个转移灶的 OMD 中 PFS 和 OS 的最强预测因子。对照组的生存情况表明 OMD 是肺癌的一个亚组，总体预后较好。
