Osorio Benedict, Yegya-Raman Nikhil, Kim Sinae, Simone Charles B, Theodorou Ross Christina, Deek Matthew P, Gaines Dakim, Zou Wei, Lin Liyong, Malhotra Jyoti, Nie Ke, Aisner Joseph, Jabbour Salma K
Department of Radiation Oncology, Rutgers Cancer Institute of New Jersey, Robert Wood Johnson Medical School, Rutgers University, New Brunswick, NJ, USA.
Department of Biostatistics, School of Public Health, Rutgers University, New Brunswick, NJ, USA.
Ann Transl Med. 2019 Mar;7(5):95. doi: 10.21037/atm.2019.02.14.
Locally advanced non-small cell lung cancer (NSCLC) may exhibit significant tumor growth before the initiation of definitive chemoradiation therapy (CRT). We thus investigated the prognostic value of pretreatment tumor growth rate as measured by specific growth rate (SGR).
We conducted a retrospective review of 42 patients with locally advanced NSCLC treated with definitive concurrent CRT. For each patient, we contoured the primary gross tumor volume (GTV) on the pretreatment diagnostic chest computed tomography (CT) scan and the radiation therapy (RT) planning CT scan. We then calculated SGR based on the primary GTV from each scan and the time interval between scans. We used log-rank tests and univariate Cox regression models to quantify differences in progression-free survival (PFS), overall survival (OS) and recurrence based on SGR.
We divided patients into two groups for analysis: those with an SGR greater than or equal to the upper tercile value of 0.94%/day (high SGR) and those with SGR less than 0.94%/day (low SGR). Patients with high SGRs versus low SGRs experienced inferior PFS (median, 5.6 13.6 months, P=0.016), without a significant difference in OS. The inferior PFS in the high SGR group persisted on multivariate analysis [adjusted hazard ratio (HR) 2.37, 95% confidence interval (CI): 1.07-5.25, P=0.034]. The risk of distant recurrence was higher in the high SGR group (HR 2.62, 95% CI: 1.08-6.38, P=0.033), but there was no difference in the risk of locoregional recurrence between groups.
Pretreatment SGR was associated with inferior PFS and distant control among patients with locally advanced NSCLC treated with concurrent CRT. Further studies in larger populations may aid in elucidating optimal SGR cut-off points for risk stratification.
局部晚期非小细胞肺癌（NSCLC）在确定性放化疗（CRT）开始前可能会出现显著的肿瘤生长。因此，我们研究了通过特定生长率（SGR）测量的预处理肿瘤生长率的预后价值。
我们对42例接受确定性同步CRT治疗的局部晚期NSCLC患者进行了回顾性研究。对于每位患者，我们在预处理诊断胸部计算机断层扫描（CT）和放射治疗（RT）计划CT扫描上勾勒出原发性大体肿瘤体积（GTV）。然后，我们根据每次扫描的原发性GTV和扫描之间的时间间隔计算SGR。我们使用对数秩检验和单变量Cox回归模型来量化基于SGR的无进展生存期（PFS）、总生存期（OS）和复发的差异。
我们将患者分为两组进行分析：SGR大于或等于上三分位数0.94%/天的患者（高SGR）和SGR小于0.94%/天的患者（低SGR）。高SGR患者与低SGR患者相比，PFS较差（中位数分别为5.6个月和13.6个月，P = 0.016），OS无显著差异。高SGR组较差的PFS在多变量分析中仍然存在[调整后的风险比（HR）为2.37，95%置信区间（CI）：1.07 - 5.25，P = 0.034]。高SGR组远处复发的风险更高（HR 2.62，95% CI：1.08 - 6.38，P = 0.033），但两组之间局部区域复发的风险没有差异。
在接受同步CRT治疗的局部晚期NSCLC患者中，预处理SGR与较差的PFS和远处控制相关。在更大人群中进行进一步研究可能有助于阐明用于风险分层的最佳SGR切点。
