预测局部晚期肺癌患者总生存期的心脏和肺部剂量。一项全国性多中心研究

Agon Olloni MD, PhD , Carsten Brink PhD , Ebbe Laugaard Lorenzen PhD , Stefan Starup Jeppesen PhD , Lone Hofmann PhD , Charlotte Kristiansen MD , Marianne Marquard Knap MD , Ditte Sloth Møller PhD , Lotte Nygård MD, PhD , Gitte Fredberg Persson MD, PhD , Rune Slot Thing PhD , Hella Maria Brøgger Sand MD , Axel Diederichsen MD, PhD , Tine Schytte MD, PhD
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引用次数: 0

摘要

导言:肺部和心脏照射对肺癌明确放疗后的总生存期(OS)有多大影响一直是个争论不休的问题。本研究利用一个全国性的局部晚期 NSCLC 患者大型队列,研究 OS 与肺部和心脏照射之间的关系。方法治疗计划来自丹麦的 6 个放疗中心,患者特征来自全国性的登记资料。混合分割工具自动划分了心脏和亚结构。提取所有结构的剂量-体积直方图,并使用主成分分析法(PCA)进行分析。结果研究对象包括 644 名患者,中位生存期为 26 个月(95% 置信区间 [CI]:24-29)。交叉验证选择了两个PCA变量纳入多变量模型。PCA1 代表心脏的照射情况,对 OS 有负面影响(危险比为 1.14;95% CI:1.04-1.26)。PCA2 代表左右平衡(右心房和左心室)照射,显示靠近右侧的肿瘤生存率更高(危险比为 0.92;95% CI:0.84-1.00)。除了两个 PCA 变量外,多变量模型还包括年龄、性别、体重指数、表现状态、肿瘤剂量和肿瘤体积。这些数据表明,如果可能,应减少心脏的总体照射剂量,以提高生存率。
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Heart and Lung Dose as Predictors of Overall Survival in Patients With Locally Advanced Lung Cancer. A National Multicenter Study

Introduction

It is an ongoing debate how much lung and heart irradiation impact overall survival (OS) after definitive radiotherapy for lung cancer. This study uses a large national cohort of patients with locally advanced NSCLC to investigate the association between OS and irradiation of lung and heart.

Methods

Treatment plans were acquired from six Danish radiotherapy centers, and patient characteristics were obtained from national registries. A hybrid segmentation tool automatically delineated the heart and substructures. Dose-volume histograms for all structures were extracted and analyzed using principal component analyses (PCAs). Parameter selection for a multivariable Cox model for OS prediction was performed using cross-validation based on bootstrapping.

Results

The population consisted of 644 patients with a median survival of 26 months (95% confidence interval [CI]: 24–29). The cross-validation selected two PCA variables to be included in the multivariable model. PCA1 represented irradiation of the heart and affected OS negatively (hazard ratio, 1.14; 95% CI: 1.04–1.26). PCA2 characterized the left-right balance (right atrium and left ventricle) irradiation, showing better survival for tumors near the right side (hazard ratio, 0.92; 95% CI: 0.84–1.00). Besides the two PCA variables, the multivariable model included age, sex, body-mass index, performance status, tumor dose, and tumor volume.

Conclusions

Besides the classic noncardiac risk factors, lung and heart doses had a negative impact on survival, while it is suggested that the left side of the heart is a more radiation dose–sensitive region. The data indicate that overall heart irradiation should be reduced to improve the OS if possible.

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来源期刊
CiteScore
4.20
自引率
0.00%
发文量
145
审稿时长
19 weeks
期刊最新文献
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