Luo Li-Mei, Wang Ying, Lin Pei-Xian, Su Chuang-Huang, Huang Bao-Tian
Department of Radiation Oncology, Shantou University Medical College, Shantou, China.
Department of Radiation Oncology, Cancer Hospital of Shantou University Medical College, Shantou, China.
Front Oncol. 2022 Mar 1;12:863502. doi: 10.3389/fonc.2022.863502. eCollection 2022.
Stereotactic body radiation therapy (SBRT) is a standard treatment for early primary lung cancer patients. However, there are few simple models for predicting the clinical outcomes of these patients. Our study analyzed the clinical outcomes, identified the prognostic factors, and developed prediction nomogram models for these patients.
We retrospectively analyzed 114 patients with primary lung cancer treated with SBRT from 2012 to 2020 at our institutions and assessed patient's clinical outcomes and levels of toxicity. Kaplan-Meier analysis with a log-rank test was used to generate the survival curve. The cut-off values of continuous factors were calculated with the X-tile tool. Potential independent prognostic factors for clinical outcomes were explored using cox regression analysis. Nomograms for clinical outcomes prediction were established with identified factors and assessed by calibration curves.
The median overall survival (OS) was 40.6 months, with 3-year OS, local recurrence free survival (LRFS), distant disease-free survival (DDFS) and progression free survival (PFS) of 56.3%, 61.3%, 72.9% and 35.8%, respectively, with grade 3 or higher toxicity rate of 7%. The cox regression analysis revealed that the clinical stage, immobilization device, and the prescription dose covering 95% of the target area (D95) were independent prognostic factors associated with OS. Moreover, the clinical stage, and immobilization device were independent prognostic factors of LRFS and PFS. The smoking status, hemoglobin (Hb) and immobilization device were significant prognostic factors for DDFS. The nomograms and calibration curves incorporating the above factors indicated good predictive accuracy.
SBRT is effective and safe for primary lung cancer. The prognostic factors associated with OS, LRFS, DDFS and PFS are proposed, and the nomograms we proposed are suitable for clinical outcomes prediction.
立体定向体部放射治疗（SBRT）是早期原发性肺癌患者的标准治疗方法。然而，用于预测这些患者临床结局的简单模型较少。我们的研究分析了临床结局，确定了预后因素，并为这些患者开发了预测列线图模型。
我们回顾性分析了2012年至2020年在我们机构接受SBRT治疗的114例原发性肺癌患者，并评估了患者的临床结局和毒性水平。采用Kaplan-Meier分析和对数秩检验生成生存曲线。使用X-tile工具计算连续因素的临界值。采用Cox回归分析探索临床结局的潜在独立预后因素。利用确定的因素建立临床结局预测列线图，并通过校准曲线进行评估。
中位总生存期（OS）为40.6个月，3年OS、局部无复发生存期（LRFS）、远处无病生存期（DDFS）和无进展生存期（PFS）分别为56.3%、61.3%、72.9%和35.8%，3级或更高毒性率为7%。Cox回归分析显示，临床分期、固定装置以及覆盖靶区95%的处方剂量（D95）是与OS相关的独立预后因素。此外，临床分期和固定装置是LRFS和PFS的独立预后因素。吸烟状态、血红蛋白（Hb）和固定装置是DDFS的重要预后因素。纳入上述因素的列线图和校准曲线显示出良好的预测准确性。
SBRT对原发性肺癌有效且安全。提出了与OS、LRFS、DDFS和PFS相关的预后因素，我们提出的列线图适用于临床结局预测。
