目的 分析器官和病灶联合定义寡转移Ⅳ期NSCLC原发灶3DRT剂量及其相关因素对生存的影响.方法 定义单器官和2个器官中每器官1个转移病灶为寡转移,共115例,分析剂量及相关因素与总生存的关系,Kaplan-Meier法计算生存并Logrank检验,Cox回归模型行多因素分析.结果 115例中位生存期(MST)为14个月,1、2、3年OS率分别为55.7％、18.3％、11.5％.原发灶剂量≥和＜63 Gy的OS比较,全组、2周期化疗获益、放化疗获益MST延长,分别为17个月和13个月(P=0.046)、17个月和13个月(P=0.037)、18个月和14个月(P=0.022);转移灶放疗、原发灶有效有延长生存的趋势,MST均为17个月和13个月(P=0.055和P=0.065);4～6周期化疗的MST为16个月和13个月(P=0.165).放化疗有效、原发灶体积＜120.1 cm3、治疗后KPS改善比无效、大体积、KPS降低患者的MST延长(15个月比12个月,P=0.036;17个月和11个月,P=0.002;14个月和10个月,P=0.031).多因素分析原发灶剂量和体积(P=0.020和P=0.001)、治疗后KPS变化(P=0.021)显著影响生存.结论 联合器官和病灶定义的寡转移Ⅳ期NSCLC化疗同期原发灶根治剂量放疗的生存期显著延长,原发灶体积、治疗后KPS是影响生存的独立预后因子.%Objective To investigate the influence of three-dimensional radiotherapy dose determined by organ-lesion combination for the primary tumor of oligometastatic stage Ⅳ non-small cell lung cancer (NSCLC) and related factors on survival.Methods Oligometastasis was defined as the metastatic lesion in only one organ or 1 metastatic lesion in each of two organs.A total of 115 patients were enrolled,and the association of dose and related factors with overall survival was investigated.The Kaplan-Meier method was used to calculate survival rates and the log-rank test was used for survival difference analysis,and the Cox regression model was used for multivariate analysis.Results Of all patients,the median survival time (MST) was 14 months,and the 1-,2-,and 3-year overall survival (OS) rates were 55.7％,18.3％,and 11.5％,respectively.All the patients,the patients benefiting from two-cycle chemotherapy,and the patients benefiting from chemoradiotherapy showed prolonged MST,and in patients receiving a primary tumor dose of ≥63 Gy or＜63 Gy,the MST was 17 months and 13 months (P=0.046),17 months and 13 months (P=0.037),and 18 months and 14 months (P=0.022),respectively.Radiotherapy for metastatic lesion and effective treatment for primary tumor tended to prolong survival time,and the MST was 17 months and 13months,respectively (P=0.055 and 0.065).The patients receiving 4-6 cycles of chemotherapy had an MST of 16 months and 13 months,respectively (P=0.165).The patients who received effective chemoradiotherapy,had a primary tumor volume of＜ 120.1 cm3,and had improvement in Karnofsky Performance Scale (KPS) after treatment showed a prolonged MST compared with those who did not respond to chemoradiotherapy and had a large primary tumor volume and a reduction in KPS (15 months vs.12 months,P=0.036;17 months vs.11 months,P=0.002;14 months vs.10 months,P=0.031).The multivariate analysis showed that primary tumor dose and volume (P=0.020 and 0.001) and the change in KPS after treatment (P=0.021) significantly affected survival.Conclusions The doses of chemotherapy and concurrent radical radiotherapy determined by organ-lesion combination for oligometastatic stage ⅣNSCLC can significantly prolong survival time,and primary tumor volume and KPS after treatment are the independent prognostic factors for survival.
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