Background: The role of postradiation systemic therapy in non-small cell lung cancer (NSCLC) patients with brain metastasis (BM) was controversial. Thus, we explored the role of Radiation Therapy Oncology Group recursive partitioning analysis (RTOG-RPA) and graded prognostic assessment (GPA) in identifying population who may benefit from postradiation systemic therapy.
Methods: The clinical data of NSCLC patients with documented BM from August 2007 to April 2015 of two hospitals were studied retrospectively. Cox regression was used for multivariate analysis. Survival of patients with or without postradiation systemic therapy was compared in subgroups stratified according to RTOG-RPA or GPA.
Results: Of 216 included patients, 67.1% received stereotactic radiosurgery (SRS), 24.1% received whole-brain radiation therapy (WBRT), and 8.8% received both. After radiotherapy, systemic therapy was administered in 58.3% of patients. Multivariate analysis found that postradiation systemic therapy (yes vs. no) (hazard ratio [HR] = 0.361, 95% confidence interval [CI] = 0.202-0.648, P = 0.001), radiation technique (SRS vs. WBRT) (HR = 0.462, 95% CI = 0.238-0.849, P = 0.022), extracranial metastasis (yes vs. no) (HR = 3.970, 95% CI = 1.757-8.970, P = 0.001), and Karnofsky performance status (<70 vs. ≥70) (HR = 5.338, 95% CI = 2.829-10.072, P < 0.001) were independent factors for survival. Further analysis found that subsequent tyrosine kinase inhibitor (TKI) therapy could significantly reduce the risk of mortality of patients in RTOG-RPA Class II (HR = 0.411, 95% CI = 0.183-0.923, P = 0.031) or with a GPA score of 1.5-2.5 (HR = 0.420, 95% CI = 0.182-0.968, P = 0.042). However, none of the subgroups stratified according to RTOG-RPA or GPA benefited from the additional conventional chemotherapy.
Conclusion: RTOG-RPA and GPA may be useful to identify beneficial populations in NSCLC patients with BM if TKIs were chosen as postradiation systemic therapy.
递归分割分析和分级预后评估在筛选非小细胞肺癌脑转移患者放疗后全身治疗获益人群中的作用摘要背景: 对于接受了头部放疗的非小细胞肺癌（non-small cell lung cancer，NSCLC）脑转移患者，后续全身治疗的作用存在争议。因此，我们对美国肿瘤放射治疗协作组递归分割分析（Radiation Therapy Oncology Group recursive partitioning analysis, RTOG-RPA）和分级预后评估（graded prognostic assessment, GPA），用于筛选全身治疗获益人群的可行性进行了研究。 方法: 对过去10年内，来自两家医院的NSCLC脑转移患者的临床资料进行回顾性分析。应用Cox回归进行多因素分析。并比较RTOG-RPA或GPA亚组内，接受或未接受放疗后全身治疗患者的生存差异。 结果: 总共216例患者进入分析，61.7%的患者接受了立体定向外科放疗（stereotactic radiosurgery，SRS）, 24.1%接受了全脑放疗（received whole-brain radiation therapy，WBRT），8.8%接受上述两种放疗。总共有58.3%的患者，在放疗后接受了全身治疗。多因素分析发现，全身治疗（有 vs.无）（hazard ratio [HR] = 0.361, 95% confidence interval [CI] = 0.202 - 0.648, P = 0.001），放疗方式（SRS vs. WBRT）（HR = 0.462, 95% CI = 0.238 - 0.849, P = 0.022），颅外转移（有vs无）（HR = 3.970, 95% CI = 1.757 - 8.970, P = 0.001）和卡氏评分（Karnofsky performance status，KPS） （<70 vs ≥70）（HR = 5.338, 95% CI = 2.829 - 10.072, P < 0.001）是脑转移后生存的独立预后因素。进一步分析发现，对于RTOG-RPA II级（HR = 0.411, 95% CI = 0.183 - 0.923, P = 0.031）或GPA 1.5-2.5分（HR = 0.420, 95% CI = 0.182 - 0.968, P = 0.042）的患者，放疗后接受酪氨酸激酶抑制剂（Tyrosine kinase inhibitors，TKIs）治疗，可显著降低患者的死亡风险。但常规化疗未发现可以降低RTOG-RPA或GPA任何亚组患者的死亡风险。 结论: 在NSCLC脑转移患者中，以TKIs作为放疗后全身治疗者，RTOG-RPA或GPA有助于筛选获益人群。.
Keywords: Chemotherapy; Non-Small Cell Lung Cancer; Recursive Partitioning Analysis; Stereotactic Radiosurgery; Tyrosine Kinase Inhibitors; Whole-Brain Radiation Therapy.