Takahisa Eriguchi1, Atsuya Takeda2, Yuichiro Tsurugai3, Naoko Sanuki3, Yuichi Kibe3, Yu Hara4, Takeshi Kaneko4, Masataka Taguri5, Naoyuki Shigematsu6. 1. Radiation Oncology Center, Ofuna Chuo Hospital, Kamakura, Japan; Department of Radiation Oncology, Saiseikai Yokohamashi Tobu Hospital, Yokohama, Japan; Department of Radiation Oncology, Keio University School of Medicine, Tokyo, Japan. 2. Radiation Oncology Center, Ofuna Chuo Hospital, Kamakura, Japan. Electronic address: takeda@1994.jukuin.keio.ac.jp. 3. Radiation Oncology Center, Ofuna Chuo Hospital, Kamakura, Japan. 4. Department of Pulmonology, Yokohama City University Graduate School of Medicine, Yokohama, Japan. 5. Department of Data Science, Yokohama City University School of Data Science, Yokohama, Japan. 6. Department of Radiation Oncology, Keio University School of Medicine, Tokyo, Japan.
Abstract
BACKGROUND: Clinical staging, as used for patients treated with stereotactic body radiotherapy (SBRT) for early-stage lung cancer, inadequately accounts for pleural invasion, which is a pathologic criteria. Considering the current situation, we analyzed effects of relationships between tumors and the pleura on treatment outcomes of SBRT for early-stage lung cancer. MATERIALS AND METHODS: Among consecutive patients treated with SBRT between 2006 and 2017, we retrospectively identified non-small cell lung cancer patients with primary tumor diameters ≤4 cm and N0M0. The relationships between tumors and the pleura were investigated. The effects of these findings on treatment outcomes were analyzed. RESULTS: We identified 386 patients which met the inclusion criteria. Among these patients, 323 patients were with tumors of 0.1-3.0 cm (T1-size), and 63 patients were with tumors of 3.1-4.0 cm (T2a-size). Among patients with T1-size tumors, 120, 134, and 23 had findings of pleural contact, pleural indentation, and pleural thickening, respectively. When we divided T1-size patients into 2 groups based on pleural contact (contact- or contact+), the 3-year cause-specific mortality and overall survival in patients with T1-size & contact+ were significantly worse than those in patients with T1-size & contact- (17.6% (95% confidence interval (CI), 10.7-25.9%) vs. 6.6% (95% CI, 3.5-11.1%), p < 0.01), and 58.2% (95% CI, 47.6-67.5%) vs. 77.6% (95% CI, 70.5-83.2%), p < 0.01). Local recurrence, regional recurrence, pleural cavity recurrence, and distant metastasis were associated with worse cause-specific mortality and overall survival. On multivariate analysis, pleural contact was associated with cause-specific mortality (hazard ratio (HR), 1.96; 95% CI, 1.09-3.52; p = 0.03) and overall survival (HR, 1.59; 95% CI, 1.08-2.34; p = 0.02). CONCLUSION: Pleural contact in clinical T1N0M0 lung cancer patients was associated with significantly worse survivals.
BACKGROUND: Clinical staging, as used for patients treated with stereotactic body radiotherapy (SBRT) for early-stage lung cancer, inadequately accounts for pleural invasion, which is a pathologic criteria. Considering the current situation, we analyzed effects of relationships between tumors and the pleura on treatment outcomes of SBRT for early-stage lung cancer. MATERIALS AND METHODS: Among consecutive patients treated with SBRT between 2006 and 2017, we retrospectively identified non-small cell lung cancerpatients with primary tumor diameters ≤4 cm and N0M0. The relationships between tumors and the pleura were investigated. The effects of these findings on treatment outcomes were analyzed. RESULTS: We identified 386 patients which met the inclusion criteria. Among these patients, 323 patients were with tumors of 0.1-3.0 cm (T1-size), and 63 patients were with tumors of 3.1-4.0 cm (T2a-size). Among patients with T1-size tumors, 120, 134, and 23 had findings of pleural contact, pleural indentation, and pleural thickening, respectively. When we divided T1-size patients into 2 groups based on pleural contact (contact- or contact+), the 3-year cause-specific mortality and overall survival in patients with T1-size & contact+ were significantly worse than those in patients with T1-size & contact- (17.6% (95% confidence interval (CI), 10.7-25.9%) vs. 6.6% (95% CI, 3.5-11.1%), p < 0.01), and 58.2% (95% CI, 47.6-67.5%) vs. 77.6% (95% CI, 70.5-83.2%), p < 0.01). Local recurrence, regional recurrence, pleural cavity recurrence, and distant metastasis were associated with worse cause-specific mortality and overall survival. On multivariate analysis, pleural contact was associated with cause-specific mortality (hazard ratio (HR), 1.96; 95% CI, 1.09-3.52; p = 0.03) and overall survival (HR, 1.59; 95% CI, 1.08-2.34; p = 0.02). CONCLUSION:Pleural contact in clinical T1N0M0 lung cancerpatients was associated with significantly worse survivals.