Yang Xue, Song Yaolin, Xu Rongjian, Yang Yaocheng, Feng Lingxin, Qi Qi, Li Hongmei, Yu Zhuang, Wang Jing, An Ning
Department of Medical Oncology, The Affiliated Hospital of Qingdao University, Qingdao, 266003, Shandong, China.
Department of Pathology, The Affiliated Hospital of Qingdao University, Qingdao, 266003, Shandong, China.
BMC Cancer. 2025 Feb 14;25(1):266. doi: 10.1186/s12885-025-13667-2.
The efficacy of prophylactic cranial irradiation (PCI) is still controversial in small cell lung cancer (SCLC) patients with pT1-2N0M0 disease after complete resection. The majority of previous studies haven't discerned the potential benefit of PCI in this subgroup of patients, probably due to the paucity of these patients and distinct treating modalities. The aim of this study is to demonstrate the potential medical benefit of PCI in these patients.
A retrospective study was conducted to evaluate the potential benefit of PCI in pT1-2N0M0 SCLC patients after complete resection. We retrospectively reviewed 112 pT1-2N0M0 SCLCs after complete resection and adjuvant chemotherapy between January 2013 and January 2022. Survival and Cox regression analysis were conducted to elucidate the potential medical benefit of PCI in these patients.
The median overall survival (OS) has not been reached. The 2-year, 5-year, 8-year OS rate was 93.7%, 73.2%, and 65.7%, respectively. Brain metastasis (BM) was observed in 17.0% (19/112) patients during the process of follow-up. PCI significantly decreased the BM actuarial risk from 23.9 to 4.9% (log-rank p = 0.0097, HR = 0.180, 95% CI: 0.041-0.778). The brain metastasis free survival (BMFS, log-rank p = 0.02) and OS (log-rank p = 0.05) in PCI cohort were also significantly longer than that of non_PCI group. Cox analysis demonstrated that PCI was an independent prognostic factor in both BM actuarial risk (HR = 0.198, 95% CI: 0.046-0.859, p = 0.031) and BMFS (HR = 0.387, 95% CI: 0.169-0.890, p = 0.025). Moreover, T2 patients showed a significant superior prognosis in terms of BM actuarial risk with comparison to those with T1 disease in non_PCI cohort (log-rank p = 0.016, HR = 3.345, 95% CI: 1.177-9.511), whereas the difference could not be observed in PCI cohort.
PCI was significantly associated with a better clinical outcome in pT1-2N0M0 SCLC patients who received complete resection and adjuvant chemotherapy, especially in T2 patients.
对于完全切除术后的pT1-2N0M0期小细胞肺癌（SCLC）患者，预防性颅脑照射（PCI）的疗效仍存在争议。以往大多数研究未能识别PCI在该亚组患者中的潜在益处，这可能是由于这类患者数量较少且治疗方式各异。本研究的目的是证明PCI对这些患者的潜在医学益处。
进行一项回顾性研究，以评估PCI对完全切除术后的pT1-2N0M0期SCLC患者的潜在益处。我们回顾性分析了2013年1月至2022年1月期间112例完全切除术后并接受辅助化疗的pT1-2N0M0期SCLC患者。进行生存分析和Cox回归分析，以阐明PCI对这些患者的潜在医学益处。
中位总生存期（OS）尚未达到。2年、5年、8年OS率分别为93.7%、73.2%和65.7%。随访过程中，17.0%（19/112）的患者出现脑转移（BM）。PCI显著降低了BM的累积风险，从23.9%降至4.9%（对数秩检验p = 0.0097，HR = 0.180，95%CI：0.041-0.778）。PCI组的无脑转移生存期（BMFS，对数秩检验p = 0.02）和OS（对数秩检验p = 0.05）也显著长于非PCI组。Cox分析表明，PCI是BM累积风险（HR = 0.198，95%CI：0.046-0.859，p = 0.031）和BMFS（HR = 0.387，95%CI：0.169-0.890，p = 0.025）的独立预后因素。此外，在非PCI组中，T2期患者在BM累积风险方面的预后显著优于T1期患者（对数秩检验p = 0.016，HR = 3.345，95%CI：1.177-9.
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