摘要
目的分析早期非小细胞肺癌(ES-NSCLC)行立体定向消融放射治疗(SABR)后的失败模式及影响因素。方法回顾性分析郑州大学附属肿瘤医院2012—2020年行SABR治疗的ES-NSCLC患者113例。分析其失败模式、复发时间、复发部位及影响复发的因素。采用Kaplan-Meier法计算局部复发率,区域淋巴结复发率及远处转移率。Log-rank检验进行单因素分析,Cox模型行多因素分析。结果中位随访时间58(6~108)个月,全组患者共45例(39.8%)出现复发,中位复发时间36个月。31例患者(27.4%)出现远处转移(DM),单纯DM 24例(21.2%);局部复发(LR)12例(10.6%),单纯LR 7例(6.2%);区域淋巴结复发(RR)11例(9.7%),单纯RR 6例(5.3%);LR+RR 1例(0.9%),LR+DM 3例(2.7%),LR+RR+DM 1例(0.9%),RR+DM 3例(2.7%)。全组患者1、2、3、4、5年复发率分别是5.4%、16.6%、27.5%、44.0%和51.2%。单因素及多因素分析结果提示,EGFR突变是复发率高的影响因素。结论单纯SABR治疗ES-NSCLC患者有较高复发率,远处转移是最常见的失败模式,尤其EGFR突变阳性患者,建议后续辅助治疗。
Objective To analyze the failure patterns and influencing factors of stereotactic ablative radiotherapy(SABR)for early-stage non-small cell lung cancer(ES-NSCLC).Methods 113 cases of ES-NSCLC treated with SABR from 2012 to 2020 in our hospital were retrospectively analyzed.The failure patterns,recurrence time,recurrence site and influencing factors were analyzed.Kaplan-Meier method was used to calculate the local recurrence rate,regional lymph node recurrence rate and distant metastasis rate.Univariate analysis was performed by Log-rank test,and multivariate analysis was performed by Cox model.Results The median follow-up time was 58 months(range:6-108 months),and a total of 45 patients(39.8%)recurred.The median recurrence time was 36 months.Distant metastasis(DM)occurred in 31 patients(27.4%)and DM alone in 24 patients(21.2%).Local recurrence(LR)was developed in 12 patients(10.6%)and LR alone in 7(6.2%).Regional lymph node recurrence(RR)occurred in 11 patients(9.7%)and RR alone in 6 patients(5.3%).LR combined with RR was observed in 1 case(0.9%),LR combined with DM in 3(2.7%),LR combined with RR and DM in 1(0.9%),and RR combined with DM in 3(2.7%).The 1-,2-,3-,4-and 5-year recurrence rates were 5.4%,16.6%,27.5%,44%and 51.2%,respectively.Univariate and multivariate analyses suggested that EGFR mutation was an influencing factor of high recurrence rate.Conclusion ES-NSCLC patients treated with SABR alone have a high recurrence rate,and DM is the most common mode of failure.Follow-up consolidation therapy is recommended,especially for EGFR mutation-positive NSCLC patients.
作者
郑晓丽
叶柯
孙亚楠
范诚诚
杨洋
王晓辉
刘杨
程宸
葛红
Zheng Xiaoli;Ye Ke;Sun Yanan;Fan Chengcheng;Yang Yang;Wang Xiaohui;Liu Yang;Cheng Chen;Ge Hong(Department of Radiation Oncology,The Affiliated Cancer Hospital of Zhengzhou University&Henan Cancer Hospital,Zheng Zhou 450008,China)
出处
《中华放射肿瘤学杂志》
CSCD
北大核心
2022年第6期519-524,共6页
Chinese Journal of Radiation Oncology
基金
国家自然科学基金面上项目(81773230)。
关键词
立体定向消融放射治疗
癌
非小细胞肺
早期
复发模式
影响因素
Stereotactic ablative radiotherapy
Carcinoma,non-small-cell lung,early stage
Recurrence pattern
Risk factor
