Wang Yaqi, Dong Xin, Yan Shi, Liu Bing, Li Xiang, Li Shaolei, Lv Chao, Cui Xinrun, Tao Ye, Yu Rong, Wu Nan
Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Department of Thoracic Surgery II, Peking University Cancer Hospital & Institute, Beijing, China.
Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Department of Radiation Oncology, Peking University Cancer Hospital & Institute, Beijing, China.
Int J Radiat Oncol Biol Phys. 2025 Jan 1;121(1):45-55. doi: 10.1016/j.ijrobp.2024.07.2324. Epub 2024 Aug 3.
Optimal local treatment for pulmonary oligometastases from colorectal cancer (CRC) remains unclear. We aimed to compare the long-term survival outcomes between surgery and stereotactic body radiation therapy (SBRT) as the initial local treatment for CRC pulmonary oligometastases.
We retrospectively reviewed 335 consecutive patients who initially underwent surgery or SBRT for CRC pulmonary metastases from 2011 to 2022, and 251 patients (173 surgery and 78 SBRT) were ultimately included. Freedom from intrathoracic progression (FFIP), progression-free survival (PFS), and overall survival (OS) were compared using stabilized inverse probability of treatment weighting (sIPTW) analysis. In addition, patterns of intrathoracic progression and subsequent treatment were analyzed.
Median follow-up was 61.6 months for surgery and 54.4 months for SBRT. After sIPTW adjustment, significant differences emerged in both FFIP and PFS between surgery and SBRT (FFIP: hazard ratio [HR] = 0.50, 95% confidence interval [CI], 0.31-0.79; PFS: HR = 0.56, 95% CI, 0.36-0.87). The 3- and 5-year FFIP rates were 58.6% and 54.8%, respectively, after surgery, and 34.6% and 31.3%, respectively, after SBRT (P = .006). The 3- and 5-year PFS rates were 49.4% and 45.2%, respectively, after surgery, and 28.8% and 26.1%, respectively, after SBRT (P = .010). However, OS was not significantly affected by treatment approach (HR = 0.93, 95% CI, 0.49-1.76). The 3- and 5-year OS rates were 85.9% and 73.1%, respectively, after surgery, and 78.9% and 68.7%, respectively, after SBRT (P = .849). Recurrence at the treated site was more prevalent after SBRT than after surgery (33.3% vs 16.9%), whereas new intrathoracic tumors occurred more frequently after surgery than after SBRT (71.8% vs 43.1%). Both groups chose radiation therapy as the primary local salvage treatment.
Notwithstanding the significant differences in FFIP and PFS between surgery and SBRT, the long-term survival of patients with CRC pulmonary oligometastases did not depend on the initial choice of the local treatment approach.
结直肠癌（CRC）肺寡转移的最佳局部治疗方案仍不明确。我们旨在比较手术和立体定向体部放射治疗（SBRT）作为CRC肺寡转移初始局部治疗的长期生存结果。
我们回顾性分析了2011年至2022年期间335例因CRC肺转移而最初接受手术或SBRT的连续患者，最终纳入251例患者（173例接受手术，78例接受SBRT）。使用稳定的治疗权重逆概率（sIPTW）分析比较无胸内进展生存期（FFIP）、无进展生存期（PFS）和总生存期（OS）。此外，还分析了胸内进展模式和后续治疗情况。
手术组的中位随访时间为61.6个月，SBRT组为54.4个月。经过sIPTW调整后，手术和SBRT在FFIP和PFS方面均出现显著差异（FFIP：风险比[HR]=0.50，95%置信区间[CI]，0.31-0.79；PFS：HR=0.56，95%CI，0.36-0.87）。手术后3年和5年的FFIP率分别为58.6%和54.8%，SBRT后分别为34.6%和31.3%（P=0.006）。手术后3年和5年的PFS率分别为49.4%和45.2%，SBRT后分别为28.8%和26.1%（P=0.010）。然而，治疗方法对OS没有显著影响（HR=0.93，95%CI，0.49-1.76）。手术后3年和5年的OS率分别为85.9%和73.1%，SBRT后分别为78.9%和68.7%（P=0.849）。SBRT后治疗部位的复发比手术更常见（33.3%对16.9%），而手术后新的胸内肿瘤比SBRT更频繁（71.8%对43.1%）。两组均选择放射治疗作为主要的局部挽救治疗。
尽管手术和SBRT在FFIP和PFS方面存在显著差异，但CRC肺寡转移患者的长期生存并不取决于局部治疗方法的初始选择。
