18F-氟脱氧葡萄糖正电子发射断层扫描指导治疗同步孤立性脑转移的非小细胞肺癌的长期生存。
Long-term Survival with 18-Fluorodeoxyglucose Positron Emission Tomography-directed Therapy in Non-small Cell Lung Cancer with Synchronous Solitary Brain Metastasis.
机构信息
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.
出版信息
Clin Oncol (R Coll Radiol). 2021 Mar;33(3):163-171. doi: 10.1016/j.clon.2020.10.010. Epub 2020 Oct 29.
AIMS
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.
MATERIALS AND METHODS
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.
RESULTS
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.
CONCLUSIONS
Definitive treatment of patients with NSCLC and SSBM staged with FDG-PET/CT can result in 5-year survivors, including those with ≥N1 disease.
目的
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。
材料和方法
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。
结果
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。
结论
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。
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