Aggressive therapy for patients with non-small cell lung carcinoma and synchronous brain-only oligometastatic disease is associated with long-term survival.
Aggressive therapy for patients with non-small cell lung carcinoma and synchronous brain-only oligometastatic disease is associated with long-term survival.
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DOI：
10.1016/j.lungcan.2014.06.001
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发表时间：
2014-08
期刊：
影响因子：
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通讯作者：
Alexander BM
中科院分区：
文献类型：
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作者：
Gray PJ;Mak RH;Yeap BY;Cryer SK;Pinnell NE;Christianson LW;Sher DJ;Arvold ND;Baldini EH;Chen AB;Kozono DE;Swanson SJ;Jackman DM;Alexander BM
以同步脑寡转移（SBO）为表现的非小细胞肺癌（NSCLC）患者的最佳治疗方法尚未明确。我们试图分析不同治疗模式对这一亚群的影响。我们回顾性分析了我院2000年1月至2011年1月间诊断为1-4例SBO的NSCLC患者。T0肿瘤或Karnofsky Performance Status <70的患者被排除在外。积极胸腔治疗（ATT）被定义为切除原发疾病或化疗，总放射剂量超过45 Gy。采用Cox比例风险和竞争风险模型分析影响患者生存和脑内首次复发的因素。纳入66例患者。中位随访时间为31.9个月。胸内病变范围I期9例，II期10例，III期47例。38例患者接受ATT治疗，28例未接受ATT治疗。接受ATT治疗的患者更年轻（中位年龄55岁vs. 60.5岁，p=0.027），但其他方面与未接受ATT治疗的患者相似。接受ATT治疗与延长中位总生存期（OS）相关（26.4个月vs 10.5个月；p<0.001），精算2年生存率为54% vs 26%。在控制年龄、胸椎分期、运动状态和初始脑治疗后，ATT仍与OS相关（HR 0.40, p=0.009）。在多变量分析中，首次脑衰竭的风险与接受ATT （HR 3.62, p=0.032）和首次联合脑治疗（HR 0.34, p=0.046）相关。对伴有SBO的非小细胞肺癌患者的胸部疾病进行积极治疗可提高生存率。对脑部疾病的谨慎管理仍然很重要，特别是对那些积极治疗的人。
Optimal therapy for patients with non-small cell lung carcinoma (NSCLC) presenting with synchronous brain-only oligometastases (SBO) is not well defined. We sought to analyze the effect of differing therapeutic paradigms in this subpopulation. We retrospectively analyzed NSCLC patients with 1-4 SBO diagnosed between 1/2000 and 1/2011 at our institution. Patients with T0 tumors or documented Karnofsky Performance Status <70 were excluded. Aggressive thoracic therapy (ATT) was defined as resection of the primary disease or chemoradiotherapy whose total radiation dose exceeded 45 Gy. Cox proportional hazards and competing risks models were used to analyze factors affecting survival and first recurrence in the brain. Sixty-six patients were included. Median follow-up was 31.9 months. Intrathoracic disease extent included 9 stage I, 10 stage II and 47 stage III patients. Thirty-eight patients received ATT, 28 did not. Patients receiving ATT were younger (median age 55 vs. 60.5 years, p=0.027) but were otherwise similar to those who did not. Receipt of ATT was associated with prolonged median overall survival (OS) (26.4 vs. 10.5 months; p<0.001) with actuarial 2-year rates of 54% vs. 26%. ATT remained associated with OS after controlling for age, thoracic stage, performance status and initial brain therapy (HR 0.40, p=0.009). On multivariate analysis, the risk of first failure in the brain was associated with receipt of ATT (HR 3.62, p=0.032) and initial combined modality brain therapy (HR 0.34, p=0.046). Aggressive management of thoracic disease in NSCLC patients with SBO is associated with improved survival. Careful management of brain disease remains important, especially for those treated aggressively.