Analysis Of Factors Associated With Prognosis Of Patients With Inoperable Stage ? Non Small Cell Lung Cancer

Objectives:Concurrent chemoradiation(cCHRT)has been confirmed as the standard treatment for unresectable stage ? non-small cell lung cancer(NSCLC),although the optimal time point for cCHRT remains unclear.Our research focused on the connection between radiation dose,survival and the timing of induction chemotherapy.Materials and methods:Patients with inoperable stage ? NSCLC were retrived from the Tumour Hospital of YunNan Province,China between January 1,2008 to December 31,2015.The Kaplan-Meier method was used to perform univariate survival analysis to determine the correlation between OS and clinical features,including gender,age,smoking history,Karnofsky's performance status(KPS)score,tumour location,lymph nodes,cycles of induction(ChT),and receipt of radiotherapy.A Cox proportional hazards algorithm using the back ward-forward and stepwise method was used in multivariate analyses.We analysed the outcome and potential prognostic factors.After eliminating patients who received a radiation dose<60 Gy and>66 Gy,we compared groups of cCHRT and sequential chemoradiation(sCHRT)patients matched for possible confounding variables.The influence of different cycles of induction chemotherapy was also compared,and a comparison of grade 3-4 hematologic toxicity was used to show the suitable cycles of induced chemotherapy.These comparisons were also made between different pathological types.Results:The median survival time was 20.7 months.Univariate analysis demonstrated that stage ?A,lower N stage,receiving thoracic radiation therapy(TRT),ECOG score of 0-1 and treatment regimen were prognostic factors for overall survival(OS).However,multivariate analyses showed that receipt of thoracic radiation therapy(TRT)(P=0.001),ECOG score(P=0.000)and lymph node stage(P=0.001)were independent prognostic factors for OS.Age,ECOG seore,TRT and stage of lymph node were prognostic factors for distant metastasis-free survival.After the cox analysis,only N stage(P=0.002,HR:1.410,95%CI:1.131-1.754)and ECOG score(P=0.021,HR:1.409,95%CI:1.053-1.886)were independent prognostic factors.We didn't found any factors related to PFS in our study.cCHRT did not show superiority of OS in our study(P=0.330),and this result differed from most previous research,perhaps due to the radiation dose.We selected patients who received 60-66 Gy,and ultimately,the cCHRT group achieved better outcomes,with a median OS of 25.2 months vs.20.1 months for the sCHRT group(P=0.019).We also found that cycles of induction chemotherapy did not interfere with survival;however,?3 cycles resulted in a higher rate of grade 3-4 haematologic toxicity(18/99 patients)compared to<3 cycles(53/103 patients),especially for those diagnosed with squamous cell cancer.In addition,higher-grade haematology toxicity and poor ECOG status were the most common reasons for abandoning cCHRT.Conclusion:1.For inoperable stage ? NSCLC,receipt of TRT(P=0.001),ECOG score(P=0.000)and lymph node stage(P=0.001)were independent prognostic factors of OS,N stage(p=0.002,HR:1.410,95%CI:1.131-1.754)and ECOG score(P=0.021,HR:1.409,95%CI:1.053-1.886)were independent prognostic factors for DMFS.2.cCHRT showed superiority only when the thoracic radiotherapy dose was 60-66 Gy.3.Cycles of induction chemotherapy did not interfere with survival.However,>3 cycles resulted in more grade 3-4 haematologic toxicity.