了解魁北克一个单一中心不可切除 III 期非小细胞肺癌患者的临床实践和生存结局。
Understanding clinical practice and survival outcomes in patients with unresectable stage III non-small-cell lung cancer in a single centre in Quebec.
机构信息
Peter Brojde Lung Cancer Centre, Sir Mortimer B. Davis Jewish General Hospital, McGill University, Montreal, QC.
AstraZeneca Canada, Mississauga, ON.
出版信息
Curr Oncol. 2020 Oct;27(5):e459-e466. doi: 10.3747/co.27.6241. Epub 2020 Oct 1.
METHODS
A retrospective cohort study considered patients 18 or more years of age diagnosed between January 2007 and May 2018 with unresectable stage iii non-small-cell lung cancer (nsclc) who received combined chemoradiation (crt). Survival was analyzed using the Kaplan-Meier method to determine median overall (os) and progression-free survival (pfs) and the associated 95% confidence intervals (cis). Cox regression analysis was performed to identify factors prognostic for survival, including age, sex, smoking status, Eastern Cooperative Oncology Group performance status (ecog ps), histology, treatment type, tumour size, and nodal status.
RESULTS
Of 226 patients diagnosed with unresectable stage iii disease, 134 (59%) received combined crt. Mean age was 63 years; most patients were white, were current smokers, had an ecog ps of 0 or 1, and had nonsquamous histology. Median pfs was 7.03 months (95% ci: 5.6 months to 8.5 months), and os for the cohort was 18.7 months (95% ci: 12.4 months to 24.8 months). Of those patients, 78% would have been eligible for durvalumab consolidation therapy. Univariate analysis demonstrated a significant os benefit ( = 0.010) for concurrent crt (ccrt) compared with sequential crt (scrt). Disease-specific survival remained significantly better in the ccrt group ( = 0.004). No difference in pfs was found between the ccrt and scrt groups. In addition, tumour size and nodal involvement were significant discriminating factors for survival ( < 0.05). In this patient cohort, 64% of patients progressed and received subsequent therapy. Based on multivariate analysis, tumour size and nodal station were the only factors predictive of survival in patients with unresectable stage iii nsclc treated with crt.
CONCLUSIONS
Combined crt has been the standard treatment for unresectable stage iii nsclc. In our study, a trend of better survival was seen for ccrt compared with scrt. Factors predictive of survival in patients with stage iii disease treated with crt were tumour size and nodal station. Most patients with stage iii disease would potentially be eligible for durvalumab maintenance therapy based on the eligibility criteria from the pacific trial. The use and effectiveness of novel treatments will have to be further studied in our real-world patient population and similar populations elsewhere.
方法
本回顾性队列研究纳入了 2007 年 1 月至 2018 年 5 月期间诊断为不可切除 III 期非小细胞肺癌（NSCLC）、接受联合放化疗（CRT）的 18 岁及以上患者。采用 Kaplan-Meier 法分析生存情况，以确定中位总生存期（OS）和无进展生存期（PFS）及其 95%置信区间（CI）。采用 Cox 回归分析确定与生存相关的预后因素，包括年龄、性别、吸烟状况、东部肿瘤协作组体力状况评分（ECOG PS）、组织学、治疗类型、肿瘤大小和淋巴结状态。
结果
在 226 例诊断为不可切除 III 期疾病的患者中，134 例（59%）接受了联合 CRT。平均年龄为 63 岁；大多数患者为白人、当前吸烟者、ECOG PS 评分为 0 或 1、组织学为非鳞状。中位 PFS 为 7.03 个月（95%CI：5.6 个月至 8.5 个月），该队列的 OS 为 18.7 个月（95%CI：12.4 个月至 24.8 个月）。在这些患者中，78%的患者有资格接受度伐利尤单抗巩固治疗。单因素分析显示，同期放化疗（CCRT）较序贯放化疗（SCRT）具有显著的 OS 获益（=0.010）。CCRT 组疾病特异性生存仍显著优于 SCRT 组（=0.004）。CCRT 组和 SCRT 组之间的 PFS 无差异。此外，肿瘤大小和淋巴结受累是生存的显著预测因素（<0.05）。在本患者队列中，64%的患者进展并接受了后续治疗。基于多因素分析，肿瘤大小和淋巴结站是 CRT 治疗不可切除 III 期 NSCLC 患者生存的唯一预测因素。
结论
联合 CRT 一直是不可切除 III 期 NSCLC 的标准治疗方法。在本研究中，与 SCRT 相比，CCRT 显示出更好的生存趋势。接受 CRT 治疗的 III 期疾病患者的生存预测因素为肿瘤大小和淋巴结站。根据 Pacific 试验的入组标准，大多数 III 期疾病患者有资格接受度伐利尤单抗维持治疗。在我们的真实世界患者人群和其他地方的类似人群中，需要进一步研究新型治疗方法的应用和有效性。
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