局部区域复发与远处转移对非小细胞肺癌患者术后总生存的影响：PORT-C随机对照试验的二次分析

Impact of locoregional recurrence versus distant metastasis on overall survival in patients with Non-Small cell lung cancer after Surgery: A secondary analysis of PORT-C RCT.

作者信息

Ma Zeliang, Liu Yunsong, Bao Yongxing, Wang Meiqi, Yang Xu, Men Yu, Wang Jianyang, Deng Lei, Zhai Yirui, Hu Chen, 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, PR 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, PR China.

出版信息

Lung Cancer. 2025 Jan;199:108063. doi: 10.1016/j.lungcan.2024.108063. Epub 2024 Dec 16.

DOI:10.1016/j.lungcan.2024.108063

PMID:39700682

Abstract

PURPOSE

The therapeutic advantage of postoperative radiation therapy (PORT) for non-small cell lung cancer (NSCLC) has not been shown to benefit overall survival (OS) according to two randomized controlled trials (RCTs), albeit an enhancement in locoregional-free survival was observed. We aimed to evaluate the relative influence of locoregional recurrence (LR) and distant metastasis (DM) on OS for patients with NSCLC after surgery.

METHODS

This was a secondary analysis of PORT-C RCT. Patients with pN2 NSCLC undergoing complete resection followed by chemotherapy were included. A dynamic prediction model was developed to evaluate the impact of LR and DM on OS. The endpoint was OS. Age, sex, smoking history, histology, Karnofsky Performance Status, tumor side, T stage, and positive lymph node were baseline factors, whereas LR and DM status were time-dependent covariates.

RESULTS

In total, 364 patients were eligible, including 214 and 150 in the non-PORT and PORT groups, respectively. DM significantly decreased OS in both the non-PORT (odds ratio [OR], 4.74; 95 % CI, 2.70-8.30; P < 0.01) and PORT (OR, 5.43; 95 % CI, 2.56-11.48; P < 0.01) groups. LR also significantly impacted OS in the non-PORT (OR, 2.09; 95 % CI, 1.12-3.93; P = 0.02) and the PORT (OR, 3.44; 95 % CI, 1.53-7.75; P < 0.01) groups. Multivariate Cox analysis identified the pT stage, positive lymph nodes, and histology as variables correlated with DM. A nomogram was developed to estimate the risk of DM. PORT did not significantly enhance OS in either the low (HR, 1.42; 95 % CI, 0.63-3.19, P = 0.40) or high-risk (HR, 0.62; 95 % CI, 0.35-1.09, P = 0.10) subgroup but in the medium-risk subgroup (HR, 0.20; 95 % CI, 0.05-0.86, P = 0.02).

CONCLUSION

DM and LR significantly impacted OS in patients with NSCLC after surgery. DM emerged as the dominant failure pattern, emphasizing more effective control of DM. PORT was beneficial for patients with a medium risk of DM.

摘要

目的

两项随机对照试验（RCT）表明，术后放射治疗（PORT）对非小细胞肺癌（NSCLC）的治疗优势并未显示出对总生存期（OS）有益，尽管观察到局部区域无复发生存期有所提高。我们旨在评估局部区域复发（LR）和远处转移（DM）对NSCLC患者术后OS的相对影响。

方法

这是对PORT-C RCT的二次分析。纳入接受了完全切除并随后进行化疗的pN2期NSCLC患者。开发了一个动态预测模型来评估LR和DM对OS的影响。终点指标为OS。年龄、性别、吸烟史、组织学类型、卡诺夫斯基体能状态、肿瘤部位、T分期和阳性淋巴结为基线因素，而LR和DM状态为时间依赖性协变量。

结果

共有364例患者符合条件，其中非PORT组214例，PORT组150例。DM在非PORT组（比值比[OR]，4.74；95%可信区间[CI]，2.70 - 8.30；P < 0.01）和PORT组（OR，5.43；95% CI，2.56 - 11.48；P < 0.01）均显著降低OS。LR在非PORT组（OR，2.09；95% CI，1.12 - 3.93；P = 0.02）和PORT组（OR，3.44；95% CI，1.53 - 7.75；P < 0.01）也显著影响OS。多因素Cox分析确定pT分期、阳性淋巴结和组织学类型为与DM相关的变量。绘制了列线图以估计DM风险。PORT在低风险（风险比[HR]，1.42；95% CI，0.63 - 3.19，P = 0.40）或高风险（HR，0.62；95% CI, 0.35 - 1.09，P = 0.10）亚组中均未显著提高OS，但在中风险亚组中（HR，0.20；95% CI，0.05 - 0.86，P = 0.02）有显著提高。