Early tumor shrinkage served as a prognostic factor for patients with stage III non-small cell lung cancer treated with concurrent chemoradiotherapy

Min Wei, Qingqing Ye, Xuan Wang, Men Wang, Yan Hu, Yonghua Yang, Jiyuan Yang, Jun Cai, Min Wei, Qingqing Ye, Xuan Wang, Men Wang, Yan Hu, Yonghua Yang, Jiyuan Yang, Jun Cai

Abstract

Background: Lung cancer is the most common cause of cancer death. About 80% of patients are diagnosed at stage III in the non-small cell lung cancer (NSCLC). It is extremely important to understand the progression of this disease which has low survival times despite the advancing treatment modalities. We aimed to investigate the relationship between early tumor shrinkage (ETS) after initial concurrent chemoradiotherapy (C-CRT) and survival outcome in patients with stage III (NSCLC).

Methods: A retrospective review of 103 patients with stage III NSCLC who had received C-CRT from January 2006 to October 2011 was performed. Patients were treated with systemic chemotherapy regimen of Cisplatin/Vp-16 and concurrent thoracic radiotherapy at a median dose of 66 Gy (range 60-70 Gy). All patients received a computed tomography (CT) examination before treatment. Also subsequently, chest CT scans were performed with the same imaging parameters at approximately 5 weeks after the initiation of treatment. ETS is here stratified by a decrease in tumor size ≥30% and <30% in the longest dimension of the target lesion within 5 weeks.

Results: Of the 103 patients, 59 ones showed a 30% decrease in tumor size, and the rest displayed a decrease of <30%. ETS showed no significant correlation with age, T classification, N classification, histological classification, smoking status, G classification, EGFR status, or acute pulmonary toxicity. In the current retrospective clinical study, Kaplan-Meier curves showed that patients with ETS ≥ 30% had a better progression-free survival and overall survival. The univariate and multivariate Cox regression analyses indicated that ETS < 30% was associated with a significantly increased risk of cancer-related death (P < .05) in stage IIINSCLC.

Conclusions: ETS may be served as a useful prognostic factor to predict the outcome of stage III NSCLC patients treated with CCRT.

Conflict of interest statement

The authors have no conflicts of interest to disclose.

Figures

Figure 1
Figure 1
The PFS and OS times were evaluated using Kaplan–Meier curves stratified by ETS ≥ 30% and ETS P < .01). (B) Patients with ETS ≥ 30% showed better OS when compared with those with ETS < 30% (P < .05). ETS = early tumor shrinkage, OS =  overall survival, PFS = progression-free survival.
Figure 2
Figure 2
OS analyses stratified ETS levels with clinicopathological characteristics, consisting of T classifications, N classifications, histological classification, smoking status, and EGFR status. (A, B) The survival curve of patients with ETS ≥ 30% or P = .496) showed no obvious difference between patients with ETS ≥ 30% and < 30% while that in EGFR no mutation panel (P = .009) had significant discrepancy. (E, F) The OS of patients with ETS ≥ 30% and <30% showed no evident distinction in squamous (P = .08) and adenocarcinoma panels (P = .151), as well as (G, H) G1 (P = .104) and G2 + G3 (P = .165) panels. (I, J) Patients with ETS ≥ 30% showed better OS in T1 + T2 (P < .001) than those in T3 + T4 (P = .254). K, L) Patients with ETS ≥ 30% had longer survival time in group N0 + N1 (P = .048), but no significant difference in group N2 + N3 (P = .412). ETS = early tumor shrinkage, EGFR = epidermal growth factor receptor, OS = overall survival.

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