开发和验证一个综合的大体肿瘤体积（GTV）-TNM 分层系统，用于补充同期放化疗治疗不可切除的局部晚期非小细胞肺癌。

Developing and validating an integrated gross tumor volume (GTV)-TNM stratification system for supplementing unresectable locally advanced non-small cell lung cancer treated with concurrent chemoradiotherapy.

机构信息

Department of Radiation Oncology, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-Sen University Cancer Center, 651 Dongfeng Road East, Guangzhou, Guangdong, 510060, People's Republic of China.

Lung Cancer Institute, Sun Yat-Sen University, Guangzhou, People's Republic of China.

出版信息

Radiat Oncol. 2020 Nov 10;15(1):260. doi: 10.1186/s13014-020-01704-2.

DOI:10.1186/s13014-020-01704-2

PMID:33168045

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC7653712/

Abstract

PURPOSE

The gross tumor volume (GTV) could be an independent prognostic factor for unresectable locally advanced non-small cell lung cancer (LANSCLC). We aimed to develop and validate a novel integrated GTV-TNM stratification system to supplement LANSCLC sub-staging in patients treated with concurrent chemoradiotherapy (CCRT).

METHODS

We performed a retrospective review of 340 patients with unresectable LANSCLC receiving definitive CCRT. All included patients were divided into two randomized cohorts. Then the Kaplan-Meier method and Cox regression were calculated to access the prognostic value of the integrated GTV-TNM stratification system, which was further validated by the area under the receiver operating characteristic curve (AUC) score and F1-score.

RESULTS

The optimal outcome-based GTV cut-off values (70 and 180 cm) of the modeling cohort were used to determine each patient's integrated GTV-TNM stratum in the whole cohort. Our results indicated that a lower integrated GTV-TNM stratum could had better overall survival and progression-free survival (all P < 0.001), which was recognized as an independent prognostic factor. Also, its prognostic value was robust in both the modeling and validation cohorts. Furthermore, the prognostic validity of the integrated GTV-TNM stratification system was validated by significantly improved AUC score (0.636 vs. 0.570, P = 0.027) and F1-score (0.655 vs. 0.615, P < 0.001), compared with TNM stage.

CONCLUSIONS

We proposed a novel integrated GTV-TNM stratification system to supplement unresectable LANSCLC sub-staging due to its prognostic value independent of TNM stage and other clinical characteristics, suggesting that it could be considered in individual treatment decision-making process.

摘要

目的

大体肿瘤体积（GTV）可能是不可切除局部晚期非小细胞肺癌（LANSCLC）的独立预后因素。我们旨在开发和验证一种新的综合 GTV-TNM 分层系统，以补充接受同步放化疗（CCRT）治疗的 LANSCLC 亚分期。

方法

我们对 340 例接受不可切除 LANSCLC 根治性 CCRT 的患者进行了回顾性分析。所有纳入的患者被分为两个随机队列。然后，使用 Kaplan-Meier 方法和 Cox 回归计算综合 GTV-TNM 分层系统的预后价值，并通过接受者操作特征曲线（AUC）评分和 F1 评分进一步验证。

结果

建模队列中基于最佳结果的 GTV 截止值（70 和 180 cm）用于确定整个队列中每个患者的综合 GTV-TNM 分层。我们的结果表明，较低的综合 GTV-TNM 分层可以获得更好的总生存期和无进展生存期（均 P < 0.001），这被认为是一个独立的预后因素。此外，其预后价值在建模和验证队列中均稳健。此外，综合 GTV-TNM 分层系统的预后有效性通过显著提高 AUC 评分（0.636 与 0.570，P = 0.027）和 F1 评分（0.655 与 0.615，P < 0.001）得到验证，与 TNM 分期相比。