放疗与亚肺叶切除手术治疗早期非小细胞肺癌对患者生存的影响比较

胡攀峰; 郭文涨; 黄婷婷; 张曼

doi:10.3969/j.issn.1000-8179.2020.17.505

放疗与亚肺叶切除手术治疗早期非小细胞肺癌对患者生存的影响比较

Comparison of the effects of radiotherapy and sublobectomy on the survival of patients with early non-small cell lung cancer

摘要

摘要:
目的： 旨在比较立体定向放射治疗（stereotactic body radiotherapy，SBRT）与亚肺叶切除（sublobar resection，SLR）治疗临床Ⅰ期非小细胞肺癌（non-small cell lung cancer，NSCLC）对患者生存的影响差异。
方法： 分析2015年5月至2017年12月就诊于中国科学院大学附属肿瘤医院的298例Ⅰ期NSCLC患者，149例接受SBRT治疗，149例接受SLR手术治疗。在CT上位于肺野外1/3的病变位置定义为外侧，否则为内侧；依据治疗方式对两组患者进行倾向性匹配，比较组间患者的局部肿瘤复发、疾病特异性生存期（diseasespecific survival，DSS）和总生存期（overall survival，OS）差异以及治疗相关并发症和不良反应。
结果： 手术组内平均手术切缘距离为2.4±0.2 cm（0.4~5.2 cm）；倾向评分匹配分析显示，手术组无复发生存期（relapse free survival，RFS）显著高于SBRT组（P=0.014），OS（P=0.58）与DSS（P=0.88）无统计学差异；对于直径超过2.0 cm的大结节，手术治疗组患者RFS更佳（P=0.035），而对于直径小于2.0cm的小结节，两组OS、DSS与RFS均无显著性差异（P>0.05）。SBRT组外侧肿瘤复发率更高，内侧肿瘤则无显著性差异；SBRT组的局部复发率较高（P=0.005）。SBRT治疗后发生2级及以上的放射性肺炎的比例为6.1%；手术治疗组15例（10.1%）患者出现气胸，术后出现谵妄、心律不齐和肺炎的比例分别为5.3%、6.1%及4.7%。
结论： 对于患有合并症的Ⅰ期NSCLC患者，手术治疗的RFS优于SBRT，但两种治疗方式的OS与DSS无显著性差异。肿瘤的大小与位置是制定治疗方案的必要考虑因素。

Abstract:
Objective: To compare the effects of stereotactic body radiotherapy (SBRT) and sublobectomy for clinical stage Ⅰ non-small cell lung cancer (NSCLC).
Methods: A total of 298 patients with stage Ⅰ NSCLC who were treated at the Cancer Hospital of the University of Chinese Academy of Science from May 2015 to December 2017 were analyzed. Among them, 149 patients received SBRT, and 149 patients underwent sublobectomy. On computed tomography, lesions located in the outer one-third of the lung field were considered to be located on the outer side. Lesions in the remaining two-thirds of the lung field were considered to be located on the inner side. Propensity score matching was performed according to the treatment method, and differences in local tumor recurrence, disease specific survival (DSS), overall survival (OS), and treatment-related complications/adverse reactions were compared between the two groups.
Results: The average surgical margin distance in the operation group was (2.4±0.2) cm (0.4-5.2) cm. Propensity score matching analysis showed that relapse-free survival (RFS) was significantly longer in the operation group than in the SBRT group (P=0.014). There were no significant differences in OS (P=0.58) or DSS (P=0.88). Surgical treatment was significantly effective for large nodules with a diameter of >2.0 cm (P=0.035). There were no significant differences in OS, DSS, or RFS between the groups for nodules with a diameter of ≤ 2.0 cm (P>0.05). The recurrence rate of tumors was higher in the outer side group with SBRT, but no significant difference in the inner side group. The local recurrence rate was higher in the SBRT group (P=0.005). After SBRT, the rate of grade ≥ 2 radiation pneumonia was 6.1%. In total, 15 patients (10.1%) developed pneumothorax after surgery, and the rates of postoperative delirium, arrhythmia, and pneumonia were 5.3%, 6.1%, and 4.7%, respectively.
Conclusions: In patients with stage Ⅰ NSCLC with comorbidities, sublobectomy resulted in a longer RFS than SBRT; however, there were no significant differences in OS or DSS between the two treatments. The size and location of the tumor must be considered while developing the treatment plan.

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