Department of Radiation Oncology, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea.
Department of Radiation Oncology, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea.
Cancer Res Treat. 2023 Jul;55(3):865-874. doi: 10.4143/crt.2022.1538. Epub 2023 Jan 19.
We investigated the clinical effects and predictive factors of severe post-chemoradiotherapy pulmonary complications (PCPC) in locally advanced non-small cell lung cancer (LA-NSCLC).
Medical records of 317 patients who underwent definitive concurrent chemoradiation (CCRT) for LA-NSCLC were reviewed retrospectively. PCPC was defined as an event of admission or emergency department visit for acute or subacute pulmonary inflammatory complications, including pneumonitis and pneumonia, within 6 months after CCRT initiation. Patient characteristics, baseline lung function tests, radiation dosimetric parameters, and laboratory tests were analyzed to investigate their association with PCPC. Prognostic endpoints were disease progression rate (DPR) and overall survival (OS).
PCPC was reported in 53 patients (16.7%). The OS of patients with PCPC was significantly worse (35.0% in 2 years) than that of patients without PCPC (67.0% in 2 years, p < 0.001). However, 2-year DPRs were 77.0% and 70.7% in patients with and without PCPC, respectively, which were not significantly different (p=0.087). In multivariate logistic regression, PCPC was independently associated with grade ≥ 1 hypoalbuminemia during CCRT (odds ratio [OR], 5.670; 95% confidence interval [CI], 2.487 to 13.40; p < 0.001), lower diffusing capacity of carbon monoxide (DLCO) (per mL/min/mmHg; OR, 0.855; 95% CI, 0.743 to 0.974; p=0.022), and higher lung V5 (per 10%; OR, 1.872; 95% CI, 1.336 to 2.699; p < 0.001).
PCPC might be a clinical endpoint to evaluate complications and predict the survival of patients subjected to CCRT for LA-NSCLC. Hypoalbuminaemia, DLCO, and lung V5 might predict PCPC in LA-NSCLC.
本研究旨在探讨局部晚期非小细胞肺癌（LA-NSCLC）患者接受根治性同步放化疗（CCRT）后严重的放化疗后肺部并发症（PCPC）的临床疗效和预测因素。
回顾性分析了 317 例接受根治性同步放化疗（CCRT）的 LA-NSCLC 患者的病历资料。PCPC 定义为 CCRT 开始后 6 个月内因急性或亚急性肺部炎症性并发症（包括放射性肺炎和放射性肺炎）而住院或急诊就诊的事件。分析患者特征、基线肺功能检查、放射剂量学参数和实验室检查与 PCPC 的关系。预后终点为疾病进展率（DPR）和总生存期（OS）。
53 例（16.7%）患者发生 PCPC。PCPC 患者的 OS 明显较差（2 年时为 35.0%），明显低于无 PCPC 患者（2 年时为 67.0%，p<0.001）。然而，有和无 PCPC 患者的 2 年 DPR 分别为 77.0%和 70.7%，差异无统计学意义（p=0.087）。多因素逻辑回归分析显示，CCRT 期间出现≥1 级低白蛋白血症（优势比[OR]，5.670；95%置信区间[CI]，2.487 至 13.40；p<0.001）、较低的一氧化碳弥散量（DLCO）（每毫升/分钟/毫米汞柱；OR，0.855；95%CI，0.743 至 0.974；p=0.022）和较高的肺 V5（每 10%；OR，1.872；95%CI，1.336 至 2.699；p<0.001）是 PCPC 的独立相关因素。
PCPC 可能是评估 LA-NSCLC 患者接受 CCRT 后并发症和预测生存的临床终点。低白蛋白血症、DLCO 和肺 V5 可能预测 LA-NSCLC 中的 PCPC。
