螺旋断层放疗立体定向体部放疗治疗早期肺癌时磨玻璃成分对预后的影响

Impact of ground-glass component on prognosis in early-stage lung cancer treated with stereotactic body radiotherapy via Helical Tomotherapy.

作者信息

Ma Jintao, Fan Shaonan, Huang Wenhan, Xu Xiaohong, Hu Yong, He Jian

机构信息

Department of Radiation Oncology, Zhongshan Hospital, Fudan University, 180 Fenglin Road, Shanghai, 200032, China.

出版信息

Radiat Oncol. 2024 Dec 18;19(1):177. doi: 10.1186/s13014-024-02571-x.

DOI:10.1186/s13014-024-02571-x

PMID:39696596

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC11654124/

Abstract

PURPOSE

This study aims to investigate the prognostic impact of ground-glass opacity (GGO)-component in early-stage lung cancer patients treated with stereotactic body radiotherapy (SBRT).

METHODS

From January 2013 to December 2022, 239 early-stage lung cancer patients (T1-2N0M0) underwent SBRT. They were categorized into two groups based on the presence of GGO-component: 65 patients in the subsolid group with a consolidation tumor ratio (CTR) between 0.25 and 1 and 174 patients in the solid group with a CTR of 1. Lung cancer-specific survival (LCSS) and progression-free survival (PFS) were analyzed using Cox regression models for both univariate and multivariate analyses to identify prognostic factors. Stabilized inverse probability of treatment weighting (IPTW) was employed for adjusting confounding factors. Recurrence incidence was assessed using competing risk analysis and compared using Gray's test.

RESULTS

In the multivariate analysis, female, peripheral location, and subsolid nodules were favorable prognostic factors for LCSS; peripheral location, subsolid nodules, and adjuvant therapy were favorable prognostic factors for PFS. Between the subsolid (n = 65) and solid groups (n = 174), the median LCSS were not reached (p = 0.003), with 3-, 5-, and 9-year LCSS rates of 94.7% versus 80.3%, 90.9% versus 64.1%, 82.7% versus 53.5%, respectively. The median PFS were 72.5 months and 50.5 months (p = 0.030), with 3-, 5-, and 9-year PFS rates of 75.4% versus 61.2%, 56.6% versus 44.9%, 48.6% versus 23.3%, respectively. After stabilized IPTW (n = 240), the median LCSS were not reached (p = 0.024), with 3-, 5-, and 9-year LCSS rates of 94.0% versus 82.4%, 92.2% versus 67.7%, 85.3% versus 58.2%, respectively. The median PFS were 60.2 months and 50.5 months (p = 0.096), with 3-, 5-, and 9-year PFS rates of 73.8% versus 61.0%, 53.5% versus 46.2%, 46.8% versus 22.4%, respectively. The subsolid group had lower rates of locoregional recurrence (LRR) (10.4% vs. 25.9%, p = 0.035) and distant metastasis (DM) (17.1% vs. 37.9%, p = 0.064) compared to the solid group.

CONCLUSIONS

The presence of GGO-component in the lesion is an independent prognostic factor for LCSS and PFS. Subsolid nodules treated with SBRT demonstrated better prognosis, with significantly lower rates of local-regional recurrence. We should highlight GGO-component as a practical indicator for risk stratification of SBRT patients to guide treatment decisions.

摘要

目的

本研究旨在探讨立体定向体部放疗（SBRT）治疗的早期肺癌患者中磨玻璃密度影（GGO）成分的预后影响。

方法

2013年1月至2022年12月，239例早期肺癌患者（T1-2N0M0）接受了SBRT。根据GGO成分的存在情况将他们分为两组：65例亚实性组患者，实性肿瘤比例（CTR）在0.25至1之间；174例实性组患者，CTR为1。采用Cox回归模型对肺癌特异性生存（LCSS）和无进展生存（PFS）进行单因素和多因素分析，以确定预后因素。采用稳定化逆概率加权法（IPTW）调整混杂因素。采用竞争风险分析评估复发率，并使用Gray检验进行比较。

结果

在多因素分析中，女性、外周位置和亚实性结节是LCSS的有利预后因素；外周位置、亚实性结节和辅助治疗是PFS的有利预后因素。亚实性组（n = 65）和实性组（n = 174）之间，中位LCSS未达到（p = 0.003），3年、5年和9年LCSS率分别为94.7%对80.3%、90.9%对64.1%、82.7%对53.5%。中位PFS分别为72.5个月和50.5个月（p = 0.030），3年、5年和9年PFS率分别为75.4%对61.2%、56.6%对44.9%、48.6%对23.3%。稳定化IPTW后（n = 240），中位LCSS未达到（p = 0.024），3年, 5年和9年LCSS率分别为94.0%对82.4%、92.2%对67.7%、85.3%对58.2%。中位PFS分别为60.2个月和50.5个月（p = 0.096），3年、5年和9年PFS率分别为73.8%对61.0%、53.5%对46.2%、46.8%对22.4%。与实性组相比，亚实性组的局部区域复发（LRR）率（10.4%对25.9%，p = 0.035）和远处转移（DM）率（17.1%对37.9%，p = 0.064）较低。