热消融联合放化疗治疗提高中晚期非小细胞肺癌的生存率：一项倾向评分匹配

Thermal oblation combined with chemoradiotherapy improves survival rate in intermediate and advanced non-small cell lung cancer：a propensity score matching

摘要:

目的：探讨热消融联合放化疗治疗中晚期非小细胞肺癌（non-small cell lung cancer，NSCLC）的临床疗效。方法：应用美国监测、流行病学和最终结果数据库（surveillance，epidemiology，and end results，SEER）收集2004年至2016年接受放化疗的Ⅲ/Ⅳ期NSCLC患者51 730例，通过倾向评分匹配法均衡组间协变量差异，Kaplan-Meier法及log-rank检验分析比较2组患者的总生存率（overall survival，OS）和肺癌特异性生存率（lung cancer specific survival，LCSS），Cox比例风险模型评估热消融联合放化疗是否为影响预后的独立危险因素。结果：经过倾向评分匹配后，热消融联合放化疗组的1年OS（52.11% vs. 45.90%，P=0.017）和1年LCSS（54.9% vs. 48.09%，P=0.008）均优于仅放化疗组。亚组分析显示，对于年龄＞70岁的患者，匹配前后热消融联合放化疗的OS和LCSS均优于仅放化疗组；而对于≤70岁的患者虽有生存获益，但差异无统计学意义。多因素分析显示肿瘤大小、M分期、治疗方法均是OS和LCSS的独立预后因素。结论：对于中晚期NSCLC患者，热消融联合放化疗可能是一种潜在的治疗方案选择，特别是对于年龄＞70岁的患者。

Abstract:

Objective：To investigate the clinical efficacy of thermal ablation combined with chemoradiotherapy in the treatment of intermediate and advanced non-small cell lung cancer（NSCLC）. Methods：Based on the surveillance，epidemiology，and end results（SEER） database，51 730 patients with stage Ⅲ/Ⅳ NSCLC who received chemoradiotherapy from 2004 to 2016 were collected. Propensity score matching（PSM） was used to balance the covariate differences between the two groups. Kaplan-Meier curves and log-rank test were used to compare the overall survival（OS） and lung cancer specific survival（LCSS） of the 2 groups. Cox proportional risk model was used to evaluate whether thermal ablation combined with chemoradiotherapy was an independent risk factor for prognosis. Results：After PSM，the thermal ablation combined with chemoradiotherapy group had better 1 year OS（52.11% vs. 45.90%，P=0.017） and 1 year LCSS（54.9% vs. 48.09%，P=0.008） than chemoradiotherapy alone group. When analyzed by subgroup，for patients aged>70 years，the OS and LCSS of thermal ablation combined with chemoradiotherapy group were better than those of chemoradiotherapy alone group before and after the PSM. For patients aged≤70 years，there was a survival benefit，but the difference was not statistically significant. Multivariate analysis showed that tumor size，M stage and treatment were independent prognostic factors for OS and LCSS. Conclusion：For patients with intermediate and advanced NSCLC，thermal ablation combined with chemoradiotherapy may be a potential treatment option，especially for those aged>70 years.