PO.TB06.01 · 肿瘤生物学

伴叶间胸膜受累的早期NSCLC中SBRT与手术的候选者识别：一项多中心回顾性研究

Candidate identification for SBRT versus surgery in early-stage NSCLC with interlobar pleural involvement: A multicenter retrospective study

编号 7364 展板 1 时间 4/22 09:00–12:00 区域 Section 26 主讲 Zhengkun Cai, MD

分会场 Biological Mechanisms of Tumor and Normal Tissue Response and Clinical Studies

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作者与单位 Authors & Affiliations

Zhengkun Cai, Zhiyong Yuan, Yue Wang

Tianjin Medical Univ. Cancer Inst. & Hospital, Tianjin, China

摘要 Abstract

中文摘要

目的：本研究旨在比较手术与立体定向体部放射治疗（SBRT）对伴叶间胸膜受累（ILPI）的早期非小细胞肺癌（ES-NSCLC）的生存结局，并进一步识别从SBRT中获益更多的患者。方法：这项回顾性研究分析了573例伴ILPI的ES-NSCLC患者，其在四个中心接受手术（n=379）或SBRT（n=194）治疗。采用倾向性评分匹配（PSM）以最大限度减少治疗组间的混杂因素。生存结局，包括癌症特异性生存（CSS）、无病生存（DFS），采用Kaplan-Meier法估计，并用log-rank检验比较。亚组分析采用Cox比例风险模型。我们还对治疗相关不良事件（TRAEs）进行了比较分析，并使用EORTC QLQ-C30评估健康相关生活质量（HRQoL）。结果：在整个队列中，3年CSS在手术和SBRT之间相当（HR，1.48，95% CI，1.0-2.3；P = 0.075）。在PSM匹配队列中，CSS和DFS未显示显著差异（CSS：HR，1.02，95% CI，0.6-1.5；P = 0.822；DFS：HR，1.38；95% CI，0.8-2.5；P = 0.374）。多变量Cox分析识别出若干CSS的独立预后因素，包括IPI特征（部位：HR，0.48，95% CI，0.3-0.8；P = 0.009；位置：HR，2.05，95% CI，1.2−3.6；P = 0.014；类型：HR，8.00，95% CI，1.8−35.1；P = 0.006）和患者特征（年龄：HR，1.88，95% CI，1.1−3.3；P = 0.027；吸烟史：HR，2.28，95% CI，1.4−3.7；P = 0.001）。至关重要的是，在70岁以上患者亚组中，与手术相比，SBRT与显著更优的CSS相关（HR，0.37，95% CI，0.2-0.8；P = 0.007）。具体而言，在70岁以上伴以下特征ILPI的SBRT患者中CSS得到改善：贴附型ILPI（HR，0.36，95% CI，0.1-1.0；P = 0.045）、左肺斜裂（OF）受累（HR，0.21，95% CI，0.1-0.7；P = 0.011），或中央型ILPI位置（HR，0.10，95% CI，0.0-0.6；P = 0.012）。相反，在小于70岁的患者以及伴外周型ILPI或右侧OF受累的患者中，手术显示出更佳的DFS。关于TRAEs，手术主要与疼痛相关（28.5%），而SBRT队列则经历疲劳（22.7%）。HRQoL显示，SBRT与情绪功能的显著更好保留相关，并避免了手术后观察到的疼痛加重，而手术在角色功能和社会功能方面显示出更大的改善。结论：对于伴ILPI的ES-NSCLC，SBRT提供了与手术相当的生存结局，且不增加TRAEs负担或损害HRQoL。患者年龄和ILPI特征是指导治疗选择的关键因素。SBRT对70岁以上患者尤为有益，特别是那些表现为贴附型ILPI、左侧OF受累或中央型ILPI的患者。

查看英文原文 English abstract

Purpose: This study aimed to compare survival outcomes between surgery and stereotactic body radiation therapy (SBRT) for early-stage non-small cell lung cancer (ES-NSCLC) with interlobar pleural involvement (ILPI), and to further identify patients who benefit more from SBRT. Methods: This retrospective study analyzed 573 ES-NSCLC patients with ILPI, treated with surgery (n=379) or SBRT (n=194) across four centers. Propensity score matching (PSM) was employed to minimize confounding factors between treatment groups. Survival outcomes, including cancer-specific survival (CSS), disease-free survival (DFS) were estimated using the Kaplan-Meier method and compared with the log-rank test. Subgroup analyses utilized Cox proportional hazards models. We also conducted a comparative analysis of treatment-related adverse events (TRAEs) and assessed health-related quality of life (HRQoL) using the EORTC QLQ-C30. Results: In the entire cohort, 3-year CSS was comparable between surgery and SBRT (HR, 1.48, 95% CI, 1.0-2.3; P = 0.075). In the PSM-matched cohort, CSS and DFS showed no significant differences (CSS: HR, 1.02, 95% CI, 0.6-1.5; P = 0.822; DFS: HR, 1.38; 95% CI, 0.8-2.5; P = 0.374). Multivariate Cox analysis identified several independent prognostic factors for CSS, including IPI features (site: HR, 0.48, 95% CI, 0.3-0.8; P = 0.009; location: HR, 2.05, 95% CI, 1.2−3.6; P = 0.014; type: HR, 8.00, 95% CI, 1.8−35.1; P = 0.006) and patient characteristics (age: HR, 1.88, 95% CI, 1.1−3.3; P = 0.027; smoking history: HR, 2.28 95% CI, 1.4−3.7; P = 0.001). Crucially, in the subgroup of patients over 70 years of age, SBRT was associated with significantly superior CSS compared to surgery (HR, 0.37, 95% CI, 0.2-0.8; P = 0.007). Specifically, CSS was improved in SBRT patients over 70 years with ILPI characterized by: Abutment-type ILPI (HR, 0.36, 95% CI, 0.1-1.0; P = 0.045), left lung oblique fissure (OF) involvement (HR, 0.21, 95% CI, 0.1-0.7; P = 0.011), or central ILPI location (HR, 0.10, 95% CI, 0.0-0.6; P = 0.012). Conversely, surgery showed better DFS in patients < 70 years and those with peripheral ILPI or right OF involvement. Regarding TRAEs, surgery was predominantly associated with pain (28.5%), while the SBRT cohort experienced fatigue (22.7%). The HRQoL showed SBRT was associated with significantly better preservation of emotional function and avoided the worsening of pain observed after surgery, which showed greater improvements in role and social function. Conclusions: SBRT offers survival outcomes comparable to surgery for ES-NSCLC with ILPI without increasing the burden of TRAEs or compromising HRQoL. Patient age and ILPI characteristics are critical factors in guiding treatment selection. SBRT is particularly beneficial for patients over 70 years, especially those presenting with abutment-type ILPI, left OF involvement, or central ILPI.

利益披露 Disclosure

Z. Cai, None.. Z. Yuan, None.. Y. Wang, None.

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