放疗相关因素对伴恶性胸腔积液非小细胞肺癌生存的影响

目的:回顾分析伴恶性胸腔积液(MPE)的非小细胞肺癌(NSCLC)原发灶放疗相关因素对生存影响。方法:2007—2019年间经病理学证实、初治的伴MPE的NSCLC共256例，其中117例纳入分析。按放疗剂量<63 Gy与≥63 Gy分为2个组，采用倾向性评分匹配法均衡组间混杂因素(卡钳值＝0.1)。 Ka...

Impact of radiotherapy-related factors on survival in non-small cell lung cancer complicated with malignant pleural effusion based on propensity score matching

Objective To analyze the radiotherapy-related factors affecting the survival of non-small cell lung cancer (NSCLC) patients complicated with malignant pleural effusion (MPE)(MPE-NSCLC). Methods From 2007 to 2019, 256 patients pathologically diagnosed with MPE-NSCLC received primary treatment. Among them, 117 cases were enrolled in this study. All patients were divided into two groups according to the radiation dose (<63Gy and≥63Gy). Propensity score matching (PSM) was performed to further adjust the confounding factors (Calipers value=0.1). The impact of radiotherapy-related factors on the overall survival (OS) was analyzed by Kaplan—Meier method, log-rank test and Cox’s regression model. Results Primary tumor radiotherapy significantly prolonged the OS (P<0.001). The radiation dose escalation (36.0-44.1Gy, 45.0-62.1Gy, 63.0-71.1Gy) of primary tumor significantly prolonged the OS (P<0.001). The corresponding median OS were 5, 13 and 18 months, respectively. Before the PSM,univariate analysis suggested that radiation dose ≥63Gy, gross tumor volume (GTV)<157.7cm³ and stations of metastatic lymph node (S-mlN)≤5 were significantly associated with better OS (all P<0.05) and T4N3 was significantly associated with worse OS (P=0.018). After the PSM,univariate analysis indicated that radiation dose ≥63Gy was significantly associated with better OS (P=0.013) and S-mlN ≤5had a tendency to prolong the OS (P=0.098). Prior to the PSM, multivariate analysis showed that radiation dose ≥63Gy was an independent favorable factor of OS (HR=0.566,95%CI 0.368-0.871,P=0.010) and GTV<157.7cm³had a tendency to prolong the OS (HR=0.679,95%CI 0.450-1.024,P=0.065). After the PSM, multivariate analysis revealed that radiation dose ≥63Gy was still an independent favorable factor of OS (HR=0.547,95%CI 0.333~0.899,P=0.017). No ≥grade 4 radiation toxicity occurred. The incidence rates of grade 3 radiation esophagitis and pneumonitis were 9.4% and 5.1%, respectively. Conclusion For MPE-NSCLC, radiotherapy dose of primary tumor may play a key role in improving OS on the basis of controllable MPE.