Factors associated with early mortality in patients treated with concurrent chemoradiotherapy for locally advanced non-small cell lung cancer
Menée à partir de données portant sur 1 245 patients atteints d'un cancer du poumon non à petites cellules de stade localement avancé et traités par chimioradiothérapie concomitante (durée médiane de suivi : 43,5 mois), cette étude identifie les facteurs associés au risque de décès précoce
Introduction : Concurrent chemoradiotherapy (con-CRT) has been recommended for fit patients with locally-advanced non-small cell lung cancer (LA-NSCLC) but is associated with toxicity and observed survival continues to be limited. Identifying factors associated with early mortality could improve patient selection and identify strategies to improve prognosis.
Methods : Analysis of a multi-institutional LA-NSCLC database comprising 1,245 patients treated with con-CRT in 13 institutions was performed to identify factors predictive of 180-day survival. Recursive partitioning analysis (RPA) was performed to identify prognostic groups for 180-day survival. Multivariable logistic regression analysis was used to create a clinical nomogram predicting 180-day survival based on important predictors from RPA.
Results : Median follow-up was 43.5 months (95% CI: 40.3-48.8) and 127 patients (10%) died within 180 days of treatment. Median, 180-day, and 1 to 5-year (by yearly increments) actuarial survival rates were 20.9 months, 90%, 71%, 45%, 32%, 27% and 22% respectively. Multivariable analysis adjusted by region identified GTV (OR ≥100 cc: 2.61; 95% CI: 1.10-6.20, p=0.029) and pulmonary function (forced expiratory volume in 1 second, FEV1) (OR < 80%: 2.53; 95% CI: 1.09-5.88, p=0.030) as significant predictors of 180-day survival. RPA resulted in a 2-class risk stratification system: low risk (GTV <100 cc or (GTV ≥100 cc and FEV1 ≥80%)) and high risk (GTV ≥100 cc and FEV1 <80%). 180-day survival rates were 93% for low risk and 79% for high risk with an OR of 4.43 (95% CI: 2.07-9.51, p<0.001), adjusted by region. A clinical nomogram predictive of 180-day survival incorporating FEV1, GTV, N stage and maximum esophagus dose yielded favorable calibration (R2=0.947).
Conclusions : This analysis has identified several risk factors associated with early mortality and suggests that future research in the optimization of pre-treatment pulmonary function and/or functional lung avoidance treatment may alter the therapeutic ratio in this patient population.
International Journal of Radiation Oncology • Biology • Physics , résumé, 2014