Department of Radiation Oncology, Sunnybrook Odette Cancer Centre, Toronto, Ontario, Canada.
Department of Oncology, University of Turin, Turin, Italy.
Int J Radiat Oncol Biol Phys. 2022 Dec 1;114(5):902-909. doi: 10.1016/j.ijrobp.2022.06.073. Epub 2022 Jun 23.
Prolonged survivorship is increasingly observed in patients with oligometastases (OM) treated with stereotactic body radiation therapy (SBRT). The purpose of this study was to study the conditional survival of patients with OM, which can provide more detailed prognostic information over time by considering time already survived.
A multi-institutional database consisting of 1033 patients with OM (≤5 metastases) treated with SBRT between 2006 and 2017 was analyzed. Conditional overall survival (OS) and progression-free survival (PFS) in 3 years were obtained at multiple time points for all patients and by primary cancer type. Cox regression was used to determine trends in conditional OS and PFS. Changes in the predictors of OS and PFS over time were also determined by multivariable Cox regression.
The median follow-up was 24 months (0.3-105 months). Three-year OS and PFS at baseline were 56.7% and 23.2%, respectively. The OS in 3 years conditional on having survived for 3, 6, 12, and 24 months did not significantly change over time (56.7%, 55.4%, 55.8%, and 50.6%, respectively; P = .60). In contrast, the probability of PFS in 3 years conditional on having survived progression-free for 3, 6, 12, and 24 months significantly increased over time (23.6%, 27.3%, 35.1%, and 48.8%, respectively; P < .001). When stratified by primary site, conditional PFS significantly increased over time for patients with colorectal, breast, or kidney cancer. Conditional OS remained stable for patients with non-small cell lung cancer or kidney cancer but significantly decreased over time for patients with prostate, breast, or colorectal cancer. Changes in significant prognostic factors of OS and PFS over time were also observed.
Analysis of conditional survival among patients with OM showed that as patients survived longer, their prognosis for further survival remained stable or decreased. However, patients who survived longer without disease progression had increased probability of PFS over time.
接受立体定向体部放射治疗（SBRT）的寡转移瘤（OM）患者的生存时间逐渐延长。本研究旨在研究 OM 患者的条件生存情况，通过考虑已经生存的时间，为患者提供更详细的预后信息。
分析了 2006 年至 2017 年间，1033 例 OM（≤5 个转移灶）患者接受 SBRT 治疗的多机构数据库。对所有患者和主要癌症类型，在多个时间点获得 3 年的条件总生存（OS）和无进展生存（PFS）。采用 Cox 回归确定条件 OS 和 PFS 的趋势。还通过多变量 Cox 回归确定 OS 和 PFS 预测因素随时间的变化。
中位随访时间为 24 个月（0.3-105 个月）。基线时的 3 年 OS 和 PFS 分别为 56.7%和 23.2%。在已经生存 3、6、12 和 24 个月的情况下，3 年内的 OS 在时间上没有显著变化（分别为 56.7%、55.4%、55.8%和 50.6%；P=0.60）。相反，在已经无进展生存 3、6、12 和 24 个月的情况下，3 年内的 PFS 概率随着时间的推移显著增加（分别为 23.6%、27.3%、35.1%和 48.8%；P<0.001）。按原发部位分层，结直肠癌、乳腺癌或肾癌患者的条件 PFS 随时间显著增加。非小细胞肺癌或肾癌患者的条件 OS 保持稳定，但前列腺癌、乳腺癌或结直肠癌患者的条件 OS 随时间显著降低。OS 和 PFS 的显著预后因素随时间的变化也观察到。
对 OM 患者的条件生存分析表明，随着患者生存时间的延长，其进一步生存的预后保持稳定或下降。然而，无疾病进展生存时间较长的患者，其 PFS 概率随时间增加。
