Peter MacCallum Cancer Centre, Radiation Oncology, Parkville, Victoria, Australia.
Peter MacCallum Cancer Centre, Radiation Oncology, Parkville, Victoria, Australia; Sir Peter MacCallum Department of Oncology, Melbourne University, Parkville, Victoria, Australia.
Clin Oncol (R Coll Radiol). 2021 Mar;33(3):163-171. doi: 10.1016/j.clon.2020.10.010. Epub 2020 Oct 29.
At diagnosis, <1% of patients with non-small cell lung cancer (NSCLC) have synchronous solitary brain metastasis (SSBM). In prior cohorts without 18-fluorodeoxyglucose positron emission tomography/computed tomography (FDG-PET/CT) staging, definitive treatment to intracranial and intrathoracic disease showed a 5-year overall survival (OS) of 11-21%. We investigated the long-term survival outcomes for patients with SSBM NSCLC, diagnosed in the FDG-PET/CT era and treated definitively with local therapies to both intracranial and intrathoracic sites of disease.
This retrospective study assessed patients staged with FDG-PET/CT who received definitive lung and SSBM treatment from February 1999 to December 2017. A lung-molecular graded prognostic assessment (lung-molGPA) score was assigned for each patient using age, performance status score, and, where carried out, molecular status. Overall survival and progression-free survival (PFS) were calculated using Kaplan-Meier methods. Cox proportional hazard models determined OS and PFS prognostic factors.
Forty-nine patients newly diagnosed with NSCLC and SSBM had a median age of 63 years (range 34-76). The median follow-up of all patients was 3.9 years. Thirty-three patients (67%) had ≥T2 disease, 23 (47%) had ≥N2. At 2 years, 45% of first failures were intracranial only (95% confidence interval 30-59). At 3 and 5 years, OS was 45% (95% confidence interval 32-63) and 30% (95% confidence interval 18-51), respectively. In ≥N1 disease, 5-year OS was 34% (95% confidence interval 18-63). The 3- and 5-year PFS was 8% (95% confidence interval 3-22) and 0%, respectively. Higher lung-molGPA was associated with longer OS (hazard ratio 0.26, 95% confidence interval 0.11-0.61, P = 0.002). Higher lung-molGPA (hazard ratio 0.33, 95% confidence interval 0.15-0.71, P = 0.005) and lower N-stage (hazard ratio 1.56, 95% confidence interval 1.13-2.15, P = 0.007) were associated with longer PFS.
Definitive treatment of patients with NSCLC and SSBM staged with FDG-PET/CT can result in 5-year survivors, including those with ≥N1 disease.
在非小细胞肺癌（NSCLC）患者中，<1%的患者在诊断时患有同步性孤立性脑转移（SSBM）。在没有 18-氟脱氧葡萄糖正电子发射断层扫描/计算机断层扫描（FDG-PET/CT）分期的情况下，对颅内和胸内疾病进行明确治疗，显示出 5 年总生存率（OS）为 11-21%。我们研究了在 FDG-PET/CT 时代诊断为 SSBM NSCLC 并接受明确的颅内和胸内疾病局部治疗的患者的长期生存结果。
本回顾性研究评估了在 1999 年 2 月至 2017 年 12 月期间使用 FDG-PET/CT 分期并接受明确肺和 SSBM 治疗的患者。为每位患者分配了肺分子分级预后评估（lung-molGPA）评分，使用年龄、表现状态评分和（如果进行）分子状态。使用 Kaplan-Meier 方法计算总生存率和无进展生存率（PFS）。Cox 比例风险模型确定了 OS 和 PFS 的预后因素。
49 例新诊断为 NSCLC 和 SSBM 的患者中位年龄为 63 岁（范围 34-76）。所有患者的中位随访时间为 3.9 年。33 例（67%）患者患有≥T2 疾病，23 例（47%）患者患有≥N2 疾病。在 2 年内，45%的首次失败为颅内孤立性（95%置信区间 30-59）。在 3 年和 5 年时，OS 分别为 45%（95%置信区间 32-63）和 30%（95%置信区间 18-51）。在≥N1 疾病中，5 年 OS 为 34%（95%置信区间 18-63）。3 年和 5 年的 PFS 分别为 8%（95%置信区间 3-22）和 0%。较高的 lung-molGPA 与较长的 OS 相关（风险比 0.26，95%置信区间 0.11-0.61，P=0.002）。较高的 lung-molGPA（风险比 0.33，95%置信区间 0.15-0.71，P=0.005）和较低的 N 期（风险比 1.56，95%置信区间 1.13-2.15，P=0.007）与较长的 PFS 相关。
使用 FDG-PET/CT 分期的 NSCLC 和 SSBM 患者的明确治疗可导致 5 年生存者，包括≥N1 疾病患者。
