a Department of Radiation Oncology , Erasmus MC Cancer Institute , Rotterdam , The Netherlands.
b Department of Radiotherapy and Oncology , Regional Cancer Centre, Indira Gandhi Medical College , Shimla , India.
Acta Oncol. 2019 Feb;58(2):237-242. doi: 10.1080/0284186X.2018.1532602. Epub 2018 Nov 19.
BACKGROUND/PURPOSE: To investigate prognostic factors for death within 6 months of stereotactic body radiotherapy (SBRT) for patients with peripheral early-stage non-small cell lung cancer (NSCLC).
This analysis included 586 NSCLC patients with peripheral tumors treated with SBRT. Potential patient and tumor prognostic factors, including the Charlson Comorbidity Index (CCI) and Cumulative Illness Rating Scale (CIRS), were analyzed by logistic regression analysis for association with early mortality (death <6 months after SBRT). Additionally, CCI and CIRS were compared with respect to their predictive ability for early mortality by comparing multivariate models with each comorbidity index, and assessing their respective discriminatory abilities (C-index).
A total of 36 patients (6.1%) died within 6 months of the start of SBRT. With a median follow-up of 25 months, 3-year overall survival was 54%. CIRS and tumor diameter were significant predictors of early mortality on multivariate analysis (p = .001). Patients with a CIRS score of 8 or higher and a tumor diameter over 3 cm had a 6-month survival of 70% versus 97% for those lacking these two features (p < .001). CCI was not predictive for early mortality on univariate nor multivariate analysis; the model containing CCI had a C-index of 0.65 versus 0.70 for the model containing CIRS.
CIRS and tumor diameter predict for early-mortality in peripheral early-stage NSCLC treated with SBRT. CIRS may be a more useful comorbidity index than CCI in this population when assessing short-term life expectancy.
背景/目的：研究立体定向体部放射治疗（SBRT）治疗周围早期非小细胞肺癌（NSCLC）患者 6 个月内死亡的预后因素。
本分析纳入了 586 例接受 SBRT 治疗的周围型肿瘤 NSCLC 患者。通过 logistic 回归分析，对包括 Charlson 合并症指数（CCI）和累积疾病评分量表（CIRS）在内的潜在患者和肿瘤预后因素与早期死亡率（SBRT 后 6 个月内死亡）进行分析。此外，通过比较包含每个合并症指数的多变量模型，并评估各自的区分能力（C 指数），比较 CCI 和 CIRS 对早期死亡率的预测能力。
共有 36 例患者（6.1%）在 SBRT 开始后 6 个月内死亡。中位随访 25 个月后，3 年总生存率为 54%。CIRS 和肿瘤直径是多变量分析中早期死亡的显著预测因素（p=0.001）。CIRS 评分≥8 分和肿瘤直径超过 3cm 的患者 6 个月生存率为 70%，而无这两种特征的患者为 97%（p<0.001）。CCI 在单变量和多变量分析中均不能预测早期死亡率；包含 CCI 的模型 C 指数为 0.65，而包含 CIRS 的模型 C 指数为 0.70。
CIRS 和肿瘤直径可预测 SBRT 治疗周围早期 NSCLC 患者的早期死亡率。在评估短期预期寿命时，CIRS 可能比 CCI 更能反映合并症。
