Understanding clinical practice and survival outcomes in patients with unresectable stage III non-small-cell lung cancer in a single centre in Quebec
Understanding clinical practice and survival outcomes in patients with unresectable stage III non-small-cell lung cancer in a single centre in Quebec
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DOI：
10.3747/co.27.6241
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发表时间：
2020-10-01
期刊：
影响因子：
2.6
通讯作者：
Small, D.
中科院分区：
文献类型：
--
作者：
Agulnik, J.;Kasymjanova, G.;Small, D.
方法回顾性队列研究纳入2007年1月至2018年5月期间诊断为不可切除的iii期非小细胞肺癌（NsCLC）患者，接受联合放化疗（CRT）。使用Kaplan-Meier方法分析生存，以确定中位总生存期（OS）和无进展生存期（PFS）以及相关的95%置信区间（CIS）。采用Cox回归分析确定影响生存的因素，包括年龄、性别、吸烟状况、东部肿瘤合作组表现状况（ECOG PS）、组织学、治疗类型、肿瘤大小和淋巴结状态。结果226例诊断为不能切除的iii期疾病患者中，134例（59%）接受联合CRT治疗。平均年龄63岁；大多数患者为白人，当前吸烟者，ECOG PS为0或1，非鳞状组织。中位PFS为7.03个月（95% CI: 5.6至8.5个月），队列的os为18.7个月（95% CI: 12.4至24.8个月）。在这些患者中，78%的患者符合durvalumab巩固治疗的条件。单因素分析表明，与顺序CRT （SORT）相比，并行CRT （CCRT）具有显著的os获益（p = 0.010）。ccRT组的疾病特异性生存率显著提高（p = 0.004）。在ccRT组和scRT组之间PFS没有差异。此外，肿瘤大小和淋巴结累及程度是影响生存率的重要因素（p < 0.05）。在该患者队列中，64%的患者进展并接受了后续治疗。基于多变量分析，肿瘤大小和淋巴结位置是CRT治疗不可切除的III期NSCLC患者生存的唯一预测因素。结论联合CRT已成为无法切除的III期非小细胞肺癌的标准治疗方法。在我们的研究中，与sCRT相比，CCRT有更好的生存趋势。预测经CRT治疗的III期疾病患者生存的因素是肿瘤大小和淋巴结位置。根据PACIFIC试验的资格标准，大多数III期疾病患者可能有资格接受durvalumab维持治疗。新疗法的使用和有效性需要在现实世界的患者群体和其他地方的类似人群中进一步研究。
Methods A retrospective cohort study considered patients 18 or more years of age diagnosed between January 2007 and May 2018 with unresectable stage iii non-small-cell lung cancer (NsCLC) who received combined chemoradiation (CRT). Survival was analyzed using the Kaplan-Meier method to determine median overall (OS) and progression-free survival (PFS) and the associated 95% confidence intervals (CIS). Cox regression analysis was performed to identify factors prognostic for survival, including age, sex, smoking status, Eastern Cooperative Oncology Group performance status (ECOG PS), histology, treatment type, tumour size, and nodal status.Results Of 226 patients diagnosed with unresectable stage iii disease, 134 (59%) received combined CRT. Mean age was 63 years; most patients were white, were current smokers, had an ECOG PS of 0 or 1, and had nonsquamous histology. Median PFS was 7.03 months (95% CI: 5.6 months to 8.5 months), and os for the cohort was 18.7 months (95% CI: 12.4 months to 24.8 months). Of those patients, 78% would have been eligible for durvalumab consolidation therapy. Univariate analysis demonstrated a significant os benefit (p = 0.010) for concurrent CRT (CCRT) compared with sequential CRT (SORT). Disease-specific survival remained significantly better in the ccRT group (p = 0.004). No difference in PFS was found between the ccRT and scRT groups. In addition, tumour size and nodal involvement were significant discriminating factors for survival (p < 0.05). In this patient cohort, 64% of patients progressed and received subsequent therapy. Based on multivariate analysis, tumour size and nodal station were the only factors predictive of survival in patients with unresectable stage III NSCLC treated with CRT.Conclusions Combined CRT has been the standard treatment for unresectable stage III NSCLC. In our study, a trend of better survival was seen for CCRT compared with sCRT. Factors predictive of survival in patients with stage III disease treated with CRT were tumour size and nodal station. Most patients with stage III disease would potentially be eligible for durvalumab maintenance therapy based on the eligibility criteria from the PACIFIC trial. The use and effectiveness of novel treatments will have to be further studied in our real-world patient population and similar populations elsewhere.