Watanabe Yui, Koide Yutaro, Shimizu Hidetoshi, Aoyama Takahiro, Shindo Yurika, Hashimoto Shingo, Tachibana Hiroyuki, Kodaira Takeshi
Department of Radiation Oncology, Aichi Cancer Center Hospital, Nagoya 464-8681, Aichi, Japan.
Department of Radiation Oncology, Daiyukai General Hospital, Ichinomiya 491-8551, Aichi, Japan.
Cancers (Basel). 2024 Sep 24;16(19):3255. doi: 10.3390/cancers16193255.
Despite advancements in treatment for patients with unresectable locally advanced non-small cell lung cancer (LA-NSCLC), overall survival (OS) remains poor. The specific effects of varying heart and lung doses on OS in LA-NSCLC patients have not been thoroughly investigated, especially their combined impact on survival. This study aimed to examine the impact on OS of both individual and combined heart and lung doses in patients with LA-NSCLC treated with radiotherapy over a three-year follow-up period. A total of 120 patients who received definitive radiotherapy for LA-NSCLC (stage III, 92.5%) from January 2015 to January 2020 were retrospectively reviewed. The endpoint in this study was OS. Each patient was followed for a fixed period of three years. Univariate Cox regression analysis showed that OS was significantly related to mean heart dose (MHD, hazard ratio [HR], 3.4 [1.8-6.3]; < 0.001), pericardium V40 (HR, 3.2 [1.7-6.0]; < 0.001), and total lung V20 (HR, 2.6 [1.4-5.0]; = 0.003), and these were independent predictors for worse OS in multivariate analysis. Kaplan-Meier curve analysis with log-rank tests revealed that survival was significantly worse in patients with higher MHD ( < 0.001), pericardium V40 ( < 0.001), and total lung V20 ( = 0.002). Combining MHD and total lung V20, and pericardium V40 and total lung V20 provided enhanced risk stratification for OS ( < 0.001 for both combinations). The combination of heart and lung doses provided enhanced and more detailed risk stratification in prediction of OS for a fixed period of three years in LA-NSCLC patients treated with radiotherapy.
尽管不可切除的局部晚期非小细胞肺癌（LA-NSCLC）患者的治疗取得了进展，但总体生存率（OS）仍然很低。不同心肺剂量对LA-NSCLC患者OS的具体影响尚未得到充分研究，尤其是它们对生存的综合影响。本研究旨在探讨在三年随访期内接受放疗的LA-NSCLC患者中，心肺剂量单独及联合作用对OS的影响。回顾性分析了2015年1月至2020年1月期间共120例接受LA-NSCLC（III期，92.5%）根治性放疗的患者。本研究的终点是OS。每位患者随访固定的三年时间。单因素Cox回归分析显示，OS与平均心脏剂量（MHD，风险比[HR]，3.4[1.8 - 6.3]；P<0.001）、心包V40（HR，3.2[1.7 - 6.0]；P<0.001）和全肺V20（HR，2.6[1.4 - 5.0]；P = 0.003）显著相关，并且在多因素分析中这些是OS较差的独立预测因素。采用对数秩检验的Kaplan-Meier曲线分析显示，MHD较高（P<0.001）、心包V40较高（P<0.001）和全肺V20较高（P = 0.002）的患者生存率显著较差。将MHD与全肺V20以及心包V40与全肺V20相结合，为OS提供了增强的风险分层（两种组合的P均<0.001）。在接受放疗的LA-NSCLC患者中，心肺剂量的组合在预测三年固定时间的OS方面提供了增强且更详细的风险分层。
