Clinical significance of pretreatment tumor growth rate for locally advanced non-small cell lung cancer
Clinical significance of pretreatment tumor growth rate for locally advanced non-small cell lung cancer
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DOI：
10.21037/atm.2019.02.14
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发表时间：
2019-03-01
影响因子：
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通讯作者：
Jabbour, Salma K.
中科院分区：
文献类型：
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作者：
Osorio, Benedict;Yegya-Raman, Nikhil;Jabbour, Salma K.
背景：局部晚期非小细胞肺癌(NSCLC)在接受明确的放化疗(CRT)前可能表现出显著的肿瘤生长。因此，我们调查了以特定生长率(SGR)衡量的治疗前肿瘤生长率的预后价值。方法：我们对42例局部晚期非小细胞肺癌患者进行了回顾性研究，这些患者接受了确定的同期CRT治疗。对于每个患者，我们在治疗前胸部计算机断层扫描(CT)和放射治疗(RT)计划CT扫描上绘制了原始大体肿瘤体积(GTV)的轮廓。然后，我们根据每次扫描的主要GTV和扫描之间的时间间隔计算SGR。结果：根据SGR将患者分为两组：SGR>0.94%/d(高SGR组)和SGR<0.94%/d(低SGR组)。高SGRS组和低SGRS组PFS较差(中位数分别为5.6月和13.6月，P=0.016)，OS差异无统计学意义。高SGR组的下位PFS坚持多因素分析[调整危险比(HR)2.37，95%可信区间(CI)：1.0 7~5.25，P=0.034]。高SGR组的远期复发风险较高(R2.62，95%CI：1.08~6.38，P=0.033)，但局部复发的风险在两组间无差异。结论：局部晚期非小细胞肺癌同期放疗前SGR与PFS差和远处控制有关。在更大人群中的进一步研究可能有助于阐明风险分层的最佳SGR分界点。
Background: Locally advanced non-small cell lung cancer (NSCLC) may exhibit significant tumor growth before the initiation of definitive chemoradiation therapy (CRT). We thus investigated the prognostic value of pretreatment tumor growth rate as measured by specific growth rate (SGR).Methods: We conducted a retrospective review of 42 patients with locally advanced NSCLC treated with definitive concurrent CRT. For each patient, we contoured the primary gross tumor volume (GTV) on the pretreatment diagnostic chest computed tomography (CT) scan and the radiation therapy (RT) planning CT scan. We then calculated SGR based on the primary GTV from each scan and the time interval between scans. We used log-rank tests and univariate Cox regression models to quantify differences in progression-free survival (PFS), overall survival (OS) and recurrence based on SGR.Results: We divided patients into two groups for analysis: those with an SGR greater than or equal to the upper tercile value of 0.94%/ day (high SGR) and those with SGR less than 0.94%/ day (low SGR). Patients with high SGRs versus low SGRs experienced inferior PFS (median, 5.6 vs. 13.6 months, P=0.016), without a significant difference in OS. The inferior PFS in the high SGR group persisted on multivariate analysis [adjusted hazard ratio (HR) 2.37, 95% confidence interval (CI): 1.07-5.25, P=0.034]. The risk of distant recurrence was higher in the high SGR group (HR 2.62, 95% CI: 1.08-6.38, P=0.033), but there was no difference in the risk of locoregional recurrence between groups.Conclusions: Pretreatment SGR was associated with inferior PFS and distant control among patients with locally advanced NSCLC treated with concurrent CRT. Further studies in larger populations may aid in elucidating optimal SGR cut-off points for risk stratification.