局部消融治疗后同步单器官寡转移肺癌脑转移的复发模式及影响 - 一项多中心分析。

Recurrence patterns and impact of brain metastases in synchronous single organ oligometastatic lung cancer following local ablative treatment - A multicenter analysis.

机构信息

Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Department of Infectious Diseases and Pulmonary Medicine, Berlin, Germany.

Department of Internal Medicine-Oncology, Carl v. Ossietzky University of Oldenburg, Pius-Hospital, Oldenburg, Germany; Department of Hematology and Oncology, Pius-Hospital, Oldenburg, Germany; Lung Cancer Network NOWEL Organisation, Pius-Hospital, Oldenburg, Germany.

出版信息

Lung Cancer. 2022 Aug;170:165-175. doi: 10.1016/j.lungcan.2022.06.017. Epub 2022 Jul 2.

DOI:10.1016/j.lungcan.2022.06.017

PMID:35803041

Abstract

INTRODUCTION

Local ablative therapy (LAT) improves survival in oligometastatic lung cancer (OMD), but there is limited information on recurrence patterns, re-treatments and in particular the role of brain metastases during the course of disease. We therefore conducted a retrospective multicenter analysis to evaluate course of disease, sequence of therapies and predictors for long-term disease-control in the brain and survival endpoints.

PATIENTS AND METHODS

Clinical data of patients with synchronous, single organ OMD with ≤4 metastases were collected from 5 certified German lung cancer centers. All patients underwent thorough initial staging including a FDG-PET/CT scan, brain imaging and mediastinal staging, if necessary, and received LAT to all sites of disease.

RESULTS

In total, 164 patients were included (median age 62 years [range 41-84], non-squamous histology 80%, N0-1 64%, single metastasis 84%), 103 had brain (cohort A), 61 extracranial metastases (cohort B). With a median follow-up of 66 months, 115 patients (70%) experienced recurrent disease with a different distribution of sites: In cohort A vs. B, brain relapses occurred in 56% vs. 18% and new distant metastases in 5% vs. 40%. In total, LAT for every relapse was possible for 25% (29/115) of the patients. Patients with initial and secondary onset brain metastases experienced long-term disease-control in the brain and subsequently favorable survival with the application of repeated LAT (disease in the brain controlled vs. not-controlled, HR 0.21, p < 0.001). Comparable long-term overall survival was observed in patients with no or isolated brain relapses (5-years OS 74% and 92%) in contrast to patients with extracranial relapses (5-years OS 19.6%, p < 0.001).

CONCLUSIONS

Repeated LAT for recurrent synchronous single organ OMD results in a long-term favorable outcome. Disease control in the brain appears crucial and likely determines survival.

摘要

介绍

局部消融治疗（LAT）可提高寡转移肺癌（OMD）患者的生存率，但关于复发模式、再治疗，尤其是疾病过程中脑转移的作用，信息有限。因此，我们进行了一项回顾性多中心分析，以评估疾病过程、治疗顺序以及预测脑内和生存终点的长期疾病控制的因素。

患者和方法

从 5 个德国肺癌中心收集了 164 例同步、单一器官 OMD 且转移灶≤4 个的患者的临床数据。所有患者均接受了全面的初始分期，包括 FDG-PET/CT 扫描、脑成像和纵隔分期（如果需要），并对所有部位的疾病进行 LAT。

结果

共纳入 164 例患者（中位年龄 62 岁[范围 41-84]，非鳞状组织学 80%，N0-1 64%，单发转移灶 84%），其中 103 例有脑转移（队列 A），61 例有颅外转移（队列 B）。中位随访 66 个月后，115 例（70%）患者出现复发性疾病，且部位分布不同：队列 A 中脑转移复发率为 56%，而队列 B 中为 18%；新的远处转移发生率分别为 5%和 40%。总的来说，对于 115 例（29%）复发患者，LAT 可用于所有复发。对于初始和继发脑转移的患者，重复 LAT 可实现脑内长期疾病控制，并随后获得良好的生存（脑内疾病控制与未控制的 HR 0.21，p<0.001）。与颅外复发患者（5 年 OS 19.6%，p<0.001）相比，无脑或孤立性脑转移复发的患者观察到长期总生存获益（5 年 OS 分别为 74%和 92%）。