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1000
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Abstract/Summary
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<jats:title>Abstract</jats:title><jats:sec>
<jats:title>Purpose</jats:title>
<jats:p>The aim of this study was to investigate a first-site-metastasis pattern (FSMP) in unresectable stage III NSCLC after concurrent chemoradiotherapy (cCRT) with or without immune checkpoint inhibition (ICI).</jats:p>
</jats:sec><jats:sec>
<jats:title>Methods</jats:title>
<jats:p>We defined three patient subgroups according to the year of initial multimodal treatment: A (2011–2014), B (2015–2017) and C (2018–2020). Different treatment-related parameters were analyzed. Observed outcome parameters were brain metastasis-free survival (BMFS), extracranial distant metastasis-free survival (ecDMFS) and distant metastasis-free survival (DMFS).</jats:p>
</jats:sec><jats:sec>
<jats:title>Results</jats:title>
<jats:p>136 patients treated between 2011 and 2020 were included with ≥ 60.0 Gy total dose and concurrent chemotherapy (cCRT); thirty-six (26%) received ICI. Median follow-up was 49.7 (range:0.7–126.1), median OS 31.2 (95% CI:16.4–30.3) months (23.4 for non-ICI vs not reached for ICI patients, <jats:italic>p</jats:italic> = 0.001).</jats:p>
<jats:p>Median BMFS/ecDMFS/DMFS in subgroups A, B and C was 14.9/16.3/14.7 months, 20.6/12.9/12.7 months and not reached (NR)/NR/36.4 months (<jats:italic>p</jats:italic> = 0.004/0.001/0.016).</jats:p>
<jats:p>For cCRT+ICI median BMFS was 53.1 vs. 19.1 months for cCRT alone (<jats:italic>p</jats:italic> = 0.005). Median ecDMFS achieved 55.2 vs. 17.9 (<jats:italic>p</jats:italic> = 0.003) and median DMFS 29.5 (95% CI: 1.4–57.6) vs 14.93 (95% CI:10.8–19.0) months (<jats:italic>p</jats:italic> = 0.031), respectively.</jats:p>
<jats:p>Multivariate analysis showed that age over 65 (HR:1.629; <jats:italic>p</jats:italic> = 0.036), GTV ≥ 78 cc (HR: 2.100; <jats:italic>p</jats:italic> = 0.002) and V20 ≥ 30 (HR: 2.400; <jats:italic>p</jats:italic> = 0.002) were negative prognosticators for BMFS and GTV ≥ 78 cc for ecDMFS (HR: 1.739; <jats:italic>p</jats:italic> = 0.027).</jats:p>
<jats:p>After onset of brain metastasis (BM), patients survived 13.3 (95% CI: 6.4–20.2) months and 8.6 months (95% CI: 1.6–15.5) after extracranial-distant-metastasis (ecDM). Patients with ecDM as FSMP reached significantly worse overall survival of 22.1 (range:14.4–29.8) vs. 40.1 (range:18.7–61.3) months (<jats:italic>p</jats:italic> = 0.034) in the rest of cohort. In contrast, BM as FSMP had no impact on OS.</jats:p>
</jats:sec><jats:sec>
<jats:title>Conclusion</jats:title>
<jats:p>This retrospective analysis of inoperable stage III NSCLC patients revealed that age over 65, V20 ≥ 30 and GTV ≥ 78 cc were prognosticators for BMFS and GTV ≥ 78 cc for ecDMFS. ICI treatment led to a significant improvement of BMFS, ecDMFS and DMFS. ecDM as FSMP was associated with significant deterioration of OS, whereas BM as FSMP was not.</jats:p>
</jats:sec>
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Hinweis
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DeepGreen-ID: fac8581c29cb4baeadeb8a253852f21f ; metadata provieded by: DeepGreen (https://www.oa-deepgreen.de/api/v1/), LIVIVO search scope life sciences (http://z3950.zbmed.de:6210/livivo), Crossref Unified Resource API (https://api.crossref.org/swagger-ui/index.html), to.science.api (https://frl.publisso.de/), ZDB JSON-API (beta) (https://zeitschriftendatenbank.de/api/), lobid - Dateninfrastruktur für Bibliotheken (https://lobid.org/resources/search)
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