Yuan Qi, Wang Wei, Zhang Qian, Wang Yuchao, Chi Chuanzhen, Xu Chunhua
Endoscopic Center of the Affiliated Brain Hospital of Nanjing Medical University, Nanjing, Jiangsu 210029, People's Republic of China.
Clinical Center of Nanjing Respiratory Diseases and Imaging, Nanjing, Jiangsu 210029, People's Republic of China.
Cancer Manag Res. 2020 Feb 25;12:1397-1403. doi: 10.2147/CMAR.S230579. eCollection 2020.
The study aimed to clarify clinical features and prognostic factors of thoracic oligo-postoperative recurrences that underwent local therapy of non-small-cell lung cancer (NSCLC).
From 2332 patients of resected pathological stage I-IIIA NSCLC between 2008 and 2015, a total of 542 patients in follow developed recurrence. Thoracic oligo-recurrence was defined as 1-3 loco-regional confined to lung lobe, hilar/mediastinal lymph nodes, bronchial stump, or chest wall. This study included 56 thoracic oligo-recurrences. Local therapy included secondary surgery, stereotactic radiotherapy, radiotherapy with a 45 Gy or higher dose, and proton radiation therapy, performed with radical intent. We retrospectively reviewed the postoperative data and performed the univariate and multivariate analysis by Kaplan-Meier methods and Cox regression models, respectively.
Thoracic Oligo-recurrence was identified in 56(542,10.3%) patients, mainly in lung lobe(n=22,39%) and regional lymph nodes(n=19,34%). Compared with distant oligo-recurrences, more of the thoracic oligo-recurrences were II-III in pathological stage at initial surgery(p=0.002) and less were adenocarcinoma(p=0.005). The 5-year postoperative survival rate and postoperative progression-free survival rate of thoracic oligo-recurrence were 10.8% and 6.7%, respectively. Median post-recurrence survival (PRS) was 31 months, and the median postoperative progression-free survival (PR-PFS) was 17 months. Multivariate analyses revealed that time to recurrence ≥ 12 months was associated with improved PRS [odds ratio (OR) 0.74, confidence interval (CI) 0.65-0.85], and regional lymph node oligo-recurrence was associated with poor PRS [OR 1.48, CI 1.38-1.60]. All the five long-term (≥5-year) progression-free survivors were with a solitary pulmonary recurrence.
Thoracic postoperative oligo-recurrence of non-small-cell lung cancer is a limited but highly heterogeneous population, with different prognosis at different recurrence sites. Local therapy for thoracic oligo-recurrence of NSCLC achieved favourable PRS in a selected population. Pulmonary solitary oligo-recurrence may achieve a long survival time.
本研究旨在阐明接受局部治疗的非小细胞肺癌（NSCLC）胸段寡转移术后复发的临床特征和预后因素。
在2008年至2015年间接受手术切除的2332例病理分期为I-IIIA期的NSCLC患者中，共有542例患者在随访中出现复发。胸段寡转移复发定义为1-3个局限于肺叶、肺门/纵隔淋巴结、支气管残端或胸壁的局部区域复发。本研究纳入了56例胸段寡转移复发患者。局部治疗包括二次手术、立体定向放射治疗、剂量≥45 Gy的放射治疗以及质子放射治疗，均以根治为目的。我们回顾性分析了术后数据，并分别采用Kaplan-Meier方法和Cox回归模型进行单因素和多因素分析。
56例（542例中的10.3%）患者出现胸段寡转移复发，主要发生在肺叶（n=22，39%）和区域淋巴结（n=19，34%）。与远处寡转移复发相比，胸段寡转移复发患者初次手术时病理分期为II-III期的更多（p=0.002），腺癌患者更少（p=0.005）。胸段寡转移复发患者的术后5年生存率和术后无进展生存率分别为10.8%和6.7%。复发后中位生存期（PRS）为31个月，术后无进展生存期（PR-PFS）中位值为17个月。多因素分析显示，复发时间≥12个月与较好的PRS相关[比值比（OR）0.74，置信区间（CI）0.65-0.85]，区域淋巴结寡转移复发与较差的PRS相关[OR 1.48，CI 1.38-1.60]。所有5例长期（≥5年）无进展生存者均为孤立性肺复发。
非小细胞肺癌胸段术后寡转移复发是一个有限但高度异质性的群体，不同复发部位的预后不同。NSCLC胸段寡转移复发的局部治疗在特定人群中取得了良好的PRS。肺部孤立性寡转移复发可能实现较长的生存时间。
