在接受术后放疗的非小细胞肺癌患者中，较高的肺部和心脏剂量分别降低早期和长期生存率。

Higher Lung and Heart Doses Decrease Early and Long-Term Survival, Respectively, in Patients With Non-Small Cell Lung Cancer Undergoing Postoperative Radiation.

作者信息

Ma Zeliang, Liu Yunsong, Bao Yongxing, Yuan Meng, Yang Xu, Men Yu, Wang Jianyang, Deng Lei, Zhai Yirui, Bi Nan, Wang Luhua, Hui Zhouguang

机构信息

Department of Radiation Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.

Department of Medical Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.

出版信息

Adv Radiat Oncol. 2023 Mar 10;8(4):101213. doi: 10.1016/j.adro.2023.101213. eCollection 2023 Jul-Aug.

DOI:10.1016/j.adro.2023.101213

PMID:37152488

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC10157112/

Abstract

PURPOSE

Cardiopulmonary toxic effects may reduce the efficacy of postoperative radiation therapy (PORT) in patients with non-small cell lung cancer (NSCLC). However, few studies have examined whether the heart and lung doses affect overall survival (OS). We investigated the correlation of heart and lung doses with OS in patients with NSCLC undergoing PORT.

METHODS AND MATERIALS

This retrospective analysis included 307 patients with NSCLC undergoing PORT. The total dose was 50 Gy. Landmark analyses were performed at 36 months, with hazard ratios (HRs) calculated separately for events occurring up to 36 months (early survival) and after 36 months (long-term survival). Stabilized inverse probability of treatment weighting (sIPTW) was performed to balance the characteristics of the high- and low-dose groups. We performed sensitivity analyses at 24 and 48 months.

RESULTS

The median follow-up period was 67.42 months. Heart doses were significantly correlated with long-term survival (HR, 1.14; = .015) but not with early survival (HR, 0.97; = .41) or whole survival (HR, 1.02; = .58). Lung doses were marginally significantly correlated with early survival (HR, 1.03; = .07) but not with long-term survival (HR, 1.00; = .85) or whole survival (HR, 1.02; = .12). Higher heart and lung doses were associated with decreased long-term and early survival, respectively, before and after sIPTW. Landmark analyses at 24 and 48 months showed consistent results.

CONCLUSIONS

For patients with NSCLC undergoing PORT, a higher heart dose was associated with decreased long-term survival, whereas a higher lung dose was associated with decreased early survival.

摘要

目的

心肺毒性作用可能会降低非小细胞肺癌（NSCLC）患者术后放疗（PORT）的疗效。然而，很少有研究探讨心脏和肺部剂量是否会影响总生存期（OS）。我们调查了接受PORT的NSCLC患者心脏和肺部剂量与OS之间的相关性。

方法和材料

这项回顾性分析纳入了307例接受PORT的NSCLC患者。总剂量为50 Gy。在36个月时进行了标志性分析，分别计算了36个月内（早期生存）和36个月后（长期生存）发生事件的风险比（HR）。进行了稳定的治疗权重逆概率（sIPTW）分析以平衡高剂量组和低剂量组的特征。我们在24个月和48个月时进行了敏感性分析。

结果

中位随访期为67.42个月。心脏剂量与长期生存显著相关（HR，1.14；P = 0.015），但与早期生存（HR，0.97；P = 0.41）或总生存（HR，1.02；P = 0.58）无关。肺部剂量与早期生存有边缘显著相关性（HR，1.03；P = 0.07），但与长期生存（HR，1.00；P = 0.85）或总生存（HR，1.02；P = 0.12）无关。在sIPTW前后，较高的心脏和肺部剂量分别与长期和早期生存降低相关。在24个月和48个月时的标志性分析显示了一致的结果。