Radiation Oncology Center, Ofuna Chuo Hospital, Kamakura, Japan; Department of Radiation Oncology, Saiseikai Yokohamashi Tobu Hospital, Yokohama, Japan; Department of Radiation Oncology, Keio University School of Medicine, Tokyo, Japan.
Radiation Oncology Center, Ofuna Chuo Hospital, Kamakura, Japan.
Radiother Oncol. 2019 May;134:191-198. doi: 10.1016/j.radonc.2019.02.005. Epub 2019 Feb 26.
Clinical staging, as used for patients treated with stereotactic body radiotherapy (SBRT) for early-stage lung cancer, inadequately accounts for pleural invasion, which is a pathologic criteria. Considering the current situation, we analyzed effects of relationships between tumors and the pleura on treatment outcomes of SBRT for early-stage lung cancer.
Among consecutive patients treated with SBRT between 2006 and 2017, we retrospectively identified non-small cell lung cancer patients with primary tumor diameters ≤4 cm and N0M0. The relationships between tumors and the pleura were investigated. The effects of these findings on treatment outcomes were analyzed.
We identified 386 patients which met the inclusion criteria. Among these patients, 323 patients were with tumors of 0.1-3.0 cm (T1-size), and 63 patients were with tumors of 3.1-4.0 cm (T2a-size). Among patients with T1-size tumors, 120, 134, and 23 had findings of pleural contact, pleural indentation, and pleural thickening, respectively. When we divided T1-size patients into 2 groups based on pleural contact (contact- or contact+), the 3-year cause-specific mortality and overall survival in patients with T1-size & contact+ were significantly worse than those in patients with T1-size & contact- (17.6% (95% confidence interval (CI), 10.7-25.9%) vs. 6.6% (95% CI, 3.5-11.1%), p < 0.01), and 58.2% (95% CI, 47.6-67.5%) vs. 77.6% (95% CI, 70.5-83.2%), p < 0.01). Local recurrence, regional recurrence, pleural cavity recurrence, and distant metastasis were associated with worse cause-specific mortality and overall survival. On multivariate analysis, pleural contact was associated with cause-specific mortality (hazard ratio (HR), 1.96; 95% CI, 1.09-3.52; p = 0.03) and overall survival (HR, 1.59; 95% CI, 1.08-2.34; p = 0.02).
Pleural contact in clinical T1N0M0 lung cancer patients was associated with significantly worse survivals.
对于接受立体定向体放射治疗（SBRT）治疗的早期肺癌患者，临床分期不能充分考虑胸膜侵犯，这是一种病理标准。鉴于这种情况，我们分析了肿瘤与胸膜之间的关系对 SBRT 治疗早期肺癌的治疗结果的影响。
在 2006 年至 2017 年间接受 SBRT 治疗的连续患者中，我们回顾性地确定了原发性肿瘤直径≤4cm 和 N0M0 的非小细胞肺癌患者。研究了肿瘤与胸膜之间的关系。分析了这些发现对治疗结果的影响。
我们确定了 386 名符合纳入标准的患者。其中，323 名患者的肿瘤大小为 0.1-3.0cm（T1 大小），63 名患者的肿瘤大小为 3.1-4.0cm（T2a 大小）。在 T1 大小肿瘤患者中，分别有 120、134 和 23 例有胸膜接触、胸膜凹陷和胸膜增厚的发现。当我们根据胸膜接触将 T1 大小患者分为 2 组（接触或接触+）时，T1 大小&接触+患者的 3 年特异性死亡率和总生存率明显差于 T1 大小&接触-患者（17.6%（95%置信区间（CI），10.7-25.9%）vs.6.6%（95% CI，3.5-11.1%），p<0.01），58.2%（95% CI，47.6-67.5%）vs.77.6%（95% CI，70.5-83.2%），p<0.01）。局部复发、区域复发、胸腔内复发和远处转移与较差的特异性死亡率和总生存率相关。多变量分析显示，胸膜接触与特异性死亡率（风险比（HR），1.96；95% CI，1.09-3.52；p=0.03）和总生存率（HR，1.59；95% CI，1.08-2.34；p=0.02）相关。
临床 T1N0M0 肺癌患者的胸膜接触与生存率显著降低相关。
