热消融联合化疗治疗 IV 期非小细胞肺癌的生存获益：倾向评分匹配分析。

Survival benefit of thermal ablation combined with chemotherapy for the treatment of stage IV nonsmall cell lung cancer: a propensity-matched analysis.

机构信息

Department of Respiratory and Critical Care Medicine, The First Affiliated Hospital of Chongqing Medical University, Chongqing Medical University, Chongqing, China.

出版信息

Int J Hyperthermia. 2022;39(1):348-357. doi: 10.1080/02656736.2022.2038281.

DOI:10.1080/02656736.2022.2038281

PMID:35164638

Abstract

OBJECTIVE

To investigate the survival benefit of thermal ablation (TA) plus chemotherapy for Stage-IV nonsmall cell lung cancer (NSCLC).

METHODS

From the Surveillance, Epidemiology and End Results (SEER) database, data of Stage-IV NSCLC patients receiving different treatment modalities (TA plus chemotherapy vs. chemotherapy) from 2004 to 2016 were retrospectively analyzed using propensity-score matching (PSM) for covariates. Kaplan-Meier curves and the log-rank test for intergroup comparison of overall survival (OS) and lung cancer-specific survival (LCSS) and subgroup analyses in the PSM cohort evaluated possible survival benefits. Cox proportional risk models evaluated independent prognostic factors.

RESULTS

Among 52,574 patients, 152 received TA plus chemotherapy. After PSM, the TA plus chemotherapy and chemotherapy groups included 150 and 445 patients, respectively. Compared to the chemotherapy group, the TA plus chemotherapy group had better OS ( = 0.042) and LCSS ( = 0.031), especially in patients aged 70 and older in age-stratified subgroup analysis; no statistically significant beneficial trend was noted for patients younger than 70 years. Subgroup analysis by tumor size showed superior OS and LCSS with TA plus chemotherapy than chemotherapy for tumors ≤3.0 cm; however, no significant difference was found in subgroups with larger tumors. Multivariate analysis showed that TA plus chemotherapy was an independent prognostic factor for OS and LCSS (hazard ratio 0.70 [95% confidence interval 0.59-0.84] and 0.70 [0.58-0.84], respectively; < 0.001).

CONCLUSION

TA plus chemotherapy is a potential treatment option for Stage-IV NSCLC, especially for patients aged 70 or older with tumor size ≤3 cm.

摘要

目的

研究热消融（TA）联合化疗治疗Ⅳ期非小细胞肺癌（NSCLC）的生存获益。

方法

本研究从监测、流行病学和最终结果（SEER）数据库中，回顾性分析了 2004 年至 2016 年期间接受不同治疗方式（TA 联合化疗与化疗）的Ⅳ期 NSCLC 患者的数据。采用倾向评分匹配（PSM）对协变量进行校正，通过 Kaplan-Meier 曲线和对数秩检验比较总生存期（OS）和肺癌特异性生存期（LCSS）的组间差异，并对 PSM 队列进行亚组分析，以评估可能的生存获益。Cox 比例风险模型评估独立预后因素。

结果

在 52574 例患者中，有 152 例接受了 TA 联合化疗。经过 PSM 后，TA 联合化疗组和化疗组分别纳入 150 例和 445 例患者。与化疗组相比，TA 联合化疗组具有更好的 OS（ = 0.042）和 LCSS（ = 0.031），尤其是在年龄分层亚组分析中年龄≥70 岁的患者；而在年龄＜70 岁的患者中则没有观察到统计学上的获益趋势。按肿瘤大小进行的亚组分析显示，对于肿瘤≤3.0cm 的患者，TA 联合化疗的 OS 和 LCSS 优于化疗；然而，在肿瘤较大的亚组中则没有发现显著差异。多因素分析表明，TA 联合化疗是 OS 和 LCSS 的独立预后因素（风险比分别为 0.70[95%置信区间 0.59-0.84]和 0.70[0.58-0.84]； < 0.001）。