University of British Columbia, Vancouver, British Columbia, Canada; Department of Medical Oncology, BC Cancer, Vancouver, British Columbia, Canada.
Department of Medical Oncology, BC Cancer, Vancouver, British Columbia, Canada.
J Thorac Oncol. 2019 Aug;14(8):1430-1439. doi: 10.1016/j.jtho.2019.04.005. Epub 2019 Apr 16.
INTRODUCTION: Curative intent treatment of stage III NSCLC is variable and influenced by both patient and disease characteristics. We performed a real-world analysis of curative therapies in stage III NSCLC, and explored the impact of known prognostic factors on outcome. METHODS: A retrospective review was completed of all patients with stage III NSCLC between January 2005 and December 2012. Cases were filtered to identify those receiving curative intent therapy including surgery, radiotherapy (RT), chemoradiotherapy (CRT), and combined modality with surgery (S + RT). Information was collected on known prognostic and predictive factors, and immunotherapy eligibility per the PACIFIC trial. The primary outcome measure was overall survival. RESULTS: A total of 638 patients with stage III NSCLC were referred and received curative intent treatment. Of these, 66 (10%) received surgery, 95 (15%) RT, 410 (64%) CRT, and 67 (11%) combined S + RT. Median overall survival (OS) was similar for surgery (28.6 mo) and CRT (27.0 mo), inferior for RT alone (17.5 mo), and superior for S + RT (55.8 mo). In a multivariate model only, Eastern Cooperative Oncology Group performance status (ECOG PS) and treatment cohort significantly influenced OS. In a case-matched analysis, the median OS for CRT was 31.9 months, compared to 55.8 months with trimodality treatment. Overall, 61% of patients receiving CRT and 88% of those receiving trimodality therapy would have been potentially eligible for adjuvant immunotherapy. CONCLUSIONS: In stage III NSCLC, the performance of surgery and CRT are similar after controlling for known prognostic factors. Radiotherapy alone is associated with worse outcomes. Combined S + RT appears to provide a significant benefit above other modalities, albeit in highly selected patients.
介绍:治疗 III 期非小细胞肺癌(NSCLC)的目的因患者和疾病特征而异。我们对 III 期 NSCLC 的治愈性治疗进行了真实世界分析,并探讨了已知预后因素对结局的影响。
方法:回顾性分析了 2005 年 1 月至 2012 年 12 月期间所有 III 期 NSCLC 患者。筛选病例以确定接受治愈性治疗(包括手术、放疗、放化疗和联合手术+放疗)的患者。收集了已知的预后和预测因素以及免疫治疗资格的信息(根据 PACIFIC 试验)。主要结局指标为总生存期。
结果:共有 638 例 III 期 NSCLC 患者被转诊并接受了治愈性治疗。其中,66 例(10%)接受了手术,95 例(15%)接受了放疗,410 例(64%)接受了放化疗,67 例(11%)接受了联合手术+放疗。手术(28.6 个月)和放化疗(27.0 个月)的中位总生存期(OS)相似,单纯放疗(17.5 个月)的中位 OS 较差,而联合手术+放疗(55.8 个月)的中位 OS 较好。仅在多变量模型中,东部肿瘤协作组体能状态(ECOG PS)和治疗队列对 OS 有显著影响。在病例匹配分析中,放化疗的中位 OS 为 31.9 个月,而三联疗法的中位 OS 为 55.8 个月。总体而言,接受放化疗的患者中有 61%,接受三联疗法的患者中有 88%可能有资格接受辅助免疫治疗。
结论:在 III 期 NSCLC 中,在控制已知预后因素后,手术和放化疗的疗效相似。单纯放疗与较差的结局相关。联合手术+放疗似乎比其他治疗方法提供了显著的益处,尽管仅限于高度选择的患者。