Department of Radiation Oncology, Albert Einstein College of Medicine and Montefiore Medical Center, Bronx, NY.
Department of Oncology, Albert Einstein College of Medicine and Montefiore Medical Center, Bronx, NY.
Clin Lung Cancer. 2022 Jun;23(4):291-299. doi: 10.1016/j.cllc.2022.02.003. Epub 2022 Mar 3.
First-line immunotherapy (IMT), with or without cytotoxic chemotherapy, is now recommended for most patients with advanced non-small cell lung cancer (NSCLC) with no targetable mutations. We reviewed outcomes for NSCLC patients treated with first-line IMT at our institution to test the hypothesis that measures of disease burden on staging FDG-PET/CT have prognostic value.
Patient, disease, and treatment details were collected. A gradient-based segmentation tool was used to delineate each PET-avid extracranial lesion. Numbers of extrathoracic lesions and metabolic tumor volumes were tabulated. Oligometastatic disease (OMD) was defined as having ≤3 extrathoracic lesions, with any number of thoracic lesions. Progression-free survival (PFS) and overall survival (OS) rates following initiation of IMT were evaluated using the Kaplan-Meier method, and predictors of PFS and OS were assessed using Cox proportional hazards models and logrank tests.
One hundred twenty-four patients met inclusion criteria, and 1143 lesions were contoured. The presence of OMD was associated with favorable PFS (median 13.1 vs. 6.9 months; P = .016) and favorable OS (median 36.5 vs. 15.4 months; P = .002). In multivariable models, OMD was associated with favorable PFS (HR = 0.64; P = .034) and favorable OS (HR = 0.61; P = .063), and metabolic tumor volumes exceeding the cohort median (88 cc) was associated with inferior OS (HR = 1.85; P = .028).
For advanced NSCLC patients receiving first-line IMT, the presence of extrathoracic OMD and low volumetric disease burden on PET are favorable prognostic factors that could be useful stratification factors in clinical trials and may influence clinical decisions about local and systemic therapy.
对于没有可靶向突变的晚期非小细胞肺癌（NSCLC）患者，目前建议采用一线免疫治疗（IMT）联合或不联合细胞毒性化疗。我们回顾了在我院接受一线 IMT 治疗的 NSCLC 患者的结果，以检验这样一个假设，即在 FDG-PET/CT 分期时疾病负担的衡量标准具有预后价值。
收集了患者、疾病和治疗的详细信息。使用基于梯度的分割工具来描绘每个 PET 摄取的颅外病变。记录了胸外病变的数量和代谢肿瘤体积。寡转移疾病（OMD）定义为≤3 个胸外病变，伴或不伴胸内病变。使用 Kaplan-Meier 法评估 IMT 起始后的无进展生存期（PFS）和总生存期（OS），使用 Cox 比例风险模型和对数秩检验评估 PFS 和 OS 的预测因素。
124 例患者符合纳入标准，共勾画了 1143 个病灶。存在 OMD 与良好的 PFS（中位 13.1 个月 vs. 6.9 个月；P=0.016）和 OS（中位 36.5 个月 vs. 15.4 个月；P=0.002）相关。在多变量模型中，OMD 与良好的 PFS（HR=0.64；P=0.034）和 OS（HR=0.61；P=0.063）相关，而代谢肿瘤体积超过队列中位数（88cc）与较差的 OS 相关（HR=1.85；P=0.028）。
对于接受一线 IMT 的晚期 NSCLC 患者，胸外 OMD 的存在和 PET 上低体积疾病负担是有利的预后因素，这些因素可能是临床试验中有用的分层因素，并可能影响局部和全身治疗的临床决策。
