Broström Erika, Isaksson Johan, Xanthoulis Panagiotis, Börjesson Rebecka, Willén Linda, Hansen Tomas, Holgersson Georg, Ekman Simon, Botling Johan, Lundström Kristina Lamberg, Micke Patrick, Lindskog Magnus
Department of Immunology, Genetics and Pathology, Uppsala University, Uppsala, Sweden.
Department of Medical Sciences, Respiratory, Allergy and Sleep Research, Uppsala University, Uppsala, Sweden.
Transl Lung Cancer Res. 2025 Jun 30;14(6):1972-1985. doi: 10.21037/tlcr-24-840. Epub 2025 Jun 24.
Chemoradiotherapy (CRT) is regarded as the treatment of choice for inoperable stage III non-small cell lung cancer (NSCLC) patients. Despite the curative intent, recurrence is frequent, and overall prognosis is poor. Thus, there is a need for clinical biomarkers to better predict outcome and to optimize treatment and follow-up. The aim of this study was to characterize a large cohort of real-world stage III NSCLC patients who received CRT with curative intent and to define parameters that could predict recurrence patterns, overall survival (OS) and survival time from recurrence.
This study is based on a cohort of 193 stage III NSCLC patients receiving CRT with curative intent in mid-Sweden during the years 2009-2018. Data was retrospectively collected from medical records. Clinical parameters, recurrence patterns, salvage treatment, histological and molecular data were analyzed and correlated to outcome.
Median follow-up was 52 months, with a median OS of 33 months. Most patients (66%) progressed, commonly within the first 3 years following CRT. Performance status and common blood markers at recurrence were associated with worse survival. The presence of driver mutations [epidermal growth factor receptor (), Kirsten rat sarcoma viral oncogene homolog ()] or metastatic spread to N3 lymph nodes increased the risk of distant recurrence. Immunotherapy as salvage treatment was associated with a significantly better prognosis.
Routine diagnostic parameters can be used to predict survival and recurrence patterns in patients receiving curative CRT. Additionally, salvage treatment with immunotherapy was the strongest factor associated with longer survival after disease recurrence.
放化疗（CRT）被视为无法手术的Ⅲ期非小细胞肺癌（NSCLC）患者的首选治疗方法。尽管有治愈目的，但复发频繁，总体预后较差。因此，需要临床生物标志物来更好地预测预后，并优化治疗和随访。本研究的目的是对一大群接受根治性CRT的真实世界Ⅲ期NSCLC患者进行特征描述，并确定可预测复发模式、总生存期（OS）和复发后生存时间的参数。
本研究基于2009年至2018年期间在瑞典中部接受根治性CRT的193例Ⅲ期NSCLC患者队列。数据从医疗记录中回顾性收集。分析临床参数、复发模式、挽救治疗、组织学和分子数据，并与预后相关联。
中位随访时间为52个月，中位OS为33个月。大多数患者（66%）病情进展，通常在CRT后的前3年内。复发时的体能状态和常见血液标志物与较差的生存率相关。驱动基因突变[表皮生长因子受体（）、 Kirsten大鼠肉瘤病毒癌基因同源物（）]的存在或转移至N3淋巴结增加了远处复发的风险。免疫治疗作为挽救治疗与显著更好的预后相关。
常规诊断参数可用于预测接受根治性CRT患者的生存和复发模式。此外，免疫治疗作为挽救治疗是疾病复发后生存期延长的最强相关因素。
