Background: With the aging of the population and the increased importance of lung cancer screening, the number of early-stage lung cancer patients has been on the rise in recent years, which can be classified into operable early-stage lung cancer and inoperable early-stage lung cancer. The most common pathological type is non-small cell lung cancer (NSCLC). Stereotactic body radiation therapy (SBRT) is the optimal treatment for inoperable early-stage NSCLC. The aim of this study was to investigate the prognosis of early-stage NSCLC patients treated with SBRT and its influencing factors in order to reduce the side effects of radiotherapy and improve the survival and quality of life.
Methods: Clinical data and follow-up outcomes of early-stage NSCLC patients treated with SBRT in our hospital from August 2010 to August 2020 were collected. Kaplan-Meier method was used to assess the prognosis, and the Cox proportional risk model was used for multivariate prognostic analysis.
Results: A total of 165 patients were included with a median follow-up time of 43.2 (range: 4.8-132.1) mon. The local control (LC) rates at 1-yr, 2-yr and 5-yr were 98.1%, 94.8% and 86.5% respectively. Karnofsky performance status (KPS) score greater than 80 was an independent prognostic factor for LC (P=0.02). The overall survival (OS) rates at 1-yr, 2-yr and 5-yr were 97.6%, 93.0% and 68.9% respectively. A biological equivalent dose when α/β=10 (BED10) greater than 132 Gy was an independent prognostic factor for OS (P=0.04). Progression-free survival (PFS) rates at 1-yr, 2-yr and 5-yr were 93.3%, 79.5% and 55.3% respectively. The distance metastasis free survival (DMFS) rates at 1-yr, 2-yr and 5-yr were 94.5%, 83.2% and 58.4% respectively. BED10 greater than 150 Gy was an independent prognostic factor for DMFS (P=0.02). The regional control (RC) rates at 1-yr, 2-yr and 5-yr were 98.8%, 95.4% and 87.9% respectively.
Conclusions: SBRT is effective in treating early-stage NSCLC. KPS greater than 80 is an independent prognostic factor for LC; BED10 greater than 132 Gy is an independent prognostic factor for OS; BED10 greater than 150 Gy is an independent prognostic factor for DMFS.
【中文题目：早期非小细胞肺癌患者立体定向放射治疗的预后分析】 【中文摘要：背景与目的 随着人口老龄化和肺癌筛查受重视程度的提高，近年来早期肺癌就诊量呈上升趋势。其病理类型以非小细胞肺癌（non-small cell lung cancer, NSCLC）为主，可被划分为可手术早期肺癌和不可手术早期肺癌。立体定向放射治疗（stereotactic body radiation therapy, SBRT）是不可手术早期NSCLC的首选治疗方法。本研究旨在探讨我院早期NSCLC患者行SBRT后的预后及其影响因素，以期提高早期NSCLC患者接受SBRT后的生存期。方法 收集2010年8月-2020年8月在我院接受SBRT的早期NSCLC患者的临床资料及随访情况，采用Kaplan-Meier法评估预后，采用Cox比例风险模型进行多因素分析寻找影响预后的因素。结果 共纳入165例患者，中位随访时间为43.2（范围：4.8-132.1）个月。1年、2年、5年局部控制（local control, LC）率分别为98.1%、94.8%和86.5%，卡氏功能状态评分（Karnofsky performance status, KPS）>80分是LC的独立预后因素（P=0.02）；1年、2年、5年总生存（overall survival, OS）率分别为97.6%、93.0%和68.9%，生物等效剂量（biological equivalent dose when α/β=10, BED10）>132 Gy是OS的独立预后因素（P=0.04）；1年、2年、5年无进展生存（progression-free survival, PFS）率分别为93.3%、79.5%和55.3%；1年、2年、5年无远处转移生存（distance metastasis free survival, DMFS）率分别为94.5%、83.2%和58.4%，BED10>150 Gy是DMFS的独立预后因素（P=0.02）；1年、2年、5年区域控制（region control, RC）率分别为98.8%、95.4%和87.9%。结论 SBRT治疗早期NSCLC疗效好，KPS>80分是影响LC的独立预后因素；BED10>132 Gy是OS的独立预后因素；BED10>150 Gy是DMFS的独立预后因素。 】 【中文关键词：肺肿瘤；立体定向放射治疗；预后】.
Keywords: Lung neoplasms; Prognosis; Stereotactic body radiation therapy.