| 段加逸,孙振伟,陈 梦,等.Ⅲ期不可切除非小细胞肺癌初治放疗对比初治化疗疗效差异及SEER数据库验证[J].肿瘤学杂志,2026,32(6):486-494. |
| Ⅲ期不可切除非小细胞肺癌初治放疗对比初治化疗疗效差异及SEER数据库验证 |
| Efficacy of Initial Radiotherapy Versus Initial Chemotherapy in Stage Ⅲ Unresectable Non-Small Cell Lung Cancer： a Comparative Study and SEER Database Validation |
| 投稿时间：2025-11-17 |
| DOI：10.11735/j.issn.1671-170X.2026.06.B006 |
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| 中文关键词: 癌，非小细胞肺 不可切除 放射疗法 药物疗法 预后 生存 |
| 英文关键词:carcinoma, non-small cell lung unresectable radiation therapy drug therapy prognosis survival |
| 基金项目:浙江省公益基础项目（LGF21H160027）；浙江省医药卫生科技计划项目（2024KY1829）；台州市抗癌协会专项课题（TACA2025-C01） |
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| 摘要点击次数: 5 |
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| 中文摘要: |
| 摘 要： ［目的］ 探讨初始治疗为放疗或化疗对Ⅲ期不可切除非小细胞肺癌（non-small cell lung cancer，NSCLC）患者生存预后的影响。［方法］ 纳入2018年1月至2024年10月于浙江省台州医院治疗的154例初诊为Ⅲ期不可切除NSCLC患者，根据初治模式分为初治放疗组（40例）和初治化疗组（114例）；并收集2018年1月至2021年12月SEER数据库中初诊为Ⅲ期不可切除NSCLC患者（n=6 610），通过倾向评分匹配（propensity score matching，PSM） 与临床入组患者按1∶2匹配，最终匹配308例患者，其中初治放疗组80例，初治化疗组228例。采用Kaplan-Meier曲线分析总生存（overall survival，OS）和无进展生存（progression-free survival，PFS）。采用Cox回归分析影响OS的预后因素。［结果］ 临床队列中，初治放疗组和初治化疗组患者的中位PFS分别为18.0个月和16.0个月（P=0.020），中位OS分别为72.0个月和28.0个月（P=0.039），3年PFS率分别为56.2%和33.5%（P=0.007）。SEER队列中，初治放疗组和初治化疗组的中位OS分别为33.0月和20.0月（P=0.047）。多因素Cox回归分析显示，在临床队列和SEER队列总人群中，免疫治疗前接受初治放疗的Ⅲ期不可切除NSCLC患者，其死亡风险明显高于初治接受化疗的患者［（风险比（hazard ratio，HR）=1.528，95%置信区间（confidence interval，CI）：1.087~2.148，P=0.015）］。［结论］ Ⅲ期不可切除NSCLC患者初始治疗模式的选择应基于患者个体化特征进行综合评估。 |
| 英文摘要: |
| Abstract：［Objective］ To compare the efficacy of initial radiotherapy versus initial chemotherapy in patients with stage Ⅲ unresectable non-small cell lung cancer (NSCLC). ［Methods］ A total of 154 patients with newly diagnosed stage Ⅲ unresectable NSCLC treated at Taizhou Hospital of Zhejiang Province from January 2018 to October 2024 were enrolled. Patients were divided into two groups based on the initial treatment modality： the initial radiotherapy group (n=40) and the initial chemotherapy group (n=114). Additionally， data of 6 610 patients with stage Ⅲ unresectable NSCLC were obtained from the SEER database (January 2018 to December 2021)， after propensity score matching (PSM) at a 1∶2 ratio with the clinical cohort， 308 patients were included， comprising 80 in the initial radiotherapy group and 228 in the initial chemotherapy group. Overall survival (OS) and progression-free survival (PFS) were estimated by the Kaplan-Meier method. Cox regression analysis was employed to identify prognostic factors for OS. ［Results］ In the clinical cohort， the median PFS was 18.0 months in the initial radiotherapy group versus 16.0 months in the initial chemotherapy group (P=0.020)， and the median OS was 72.0 months versus 28.0 months (P=0.039)， with 3-year PFS rates of 56.2% and 33.5%， respectively (P=0.007). In the SEER database cohort， the median OS was 33.0 months versus 20.0 months (P=0.047). Multivariate Cox regression analysis revealed that in the pooled analysis of the clinical and SEER database cohorts， patients receiving initial radiotherapy had a significantly higher risk of death compared with those receiving initial chemotherapy ［hazard ratio (HR)=1.528， 95% confidence interval(CI)： 1.087~2.148， P=0.015］. ［Conclusion］ The selection of initial radiotherapy versus initial chemotherapy for patients with stage Ⅲ unresectable NSCLC should be based on a comprehensive assessment of individual patient characteristics. |
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