1Department of Radiation Oncology, Seoul National University Hospital, Seoul, Korea
2Department of Radiation Oncology, Seoul National University College of Medicine, Seoul, Korea
3Cancer Research Institute, Seoul National University College of Medicine, Seoul, Korea
4Department of Radiation Oncology, Seoul Metropolitan Government-Seoul National University Boramae Medical Center, Seoul, Korea
5Department of Internal Medicine, Seoul National University Hospital, Seoul, Korea
6Department of Internal Medicine, Seoul Metropolitan Government-Seoul National University Boramae Medical Center, Seoul, Korea
Copyright © 2023 by the Korean Cancer Association
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Patient characteristics
Characteristic | PCI (n=211) | No PCI (n=60) | p-value |
---|---|---|---|
Age (yr) | 65 (39–79) | 70 (44–93) | < 0.001 |
Sex | |||
Male | 175 (82.9) | 51 (85.0) | 0.779 |
Female | 36 (17.1) | 9 (15.0) | |
Smoking history | 171 (81.0) | 52 (86.7) | 0.415 |
Pack-year of smokers | 40 (5–120) | 45 (10–100) | 0.051 |
FEV1 (L) | 2.29 (0.99–4.05) | 2.15 (1.04–3.63) | 0.073 |
FEV1/FVC (%) | 68 (35–89) | 67 (43–91) | 0.346 |
ECOG performance status at presentation | |||
0–1 | 199 (94.3) | 53 (88.3) | 0.189 |
2–3 | 12 (5.7) | 7 (11.7) | |
Clinical T category | |||
T1 | 74 (35.1) | 20 (33.3) | 0.840 |
T2 | 57 (27.0) | 17 (28.3) | |
T3 | 36 (17.1) | 8 (13.3) | |
T4 | 44 (20.8) | 15 (25.0) | |
Clinical N category | |||
N0 | 27 (12.8) | 9 (15.0) | 0.814 |
N1 | 24 (11.4) | 9 (15.0) | |
N2 | 115 (54.5) | 31 (51.7) | |
N3 | 45 (21.3) | 11 (18.3) | |
Disease stage (AJCC 8th) | |||
IA | 11 (5.2) | 4 (6.7) | 0.771 |
IB | 3 (1.4) | 3 (5.0) | |
IIA | 3 (1.4) | 1 (1.7) | |
IIB | 24 (11.4) | 7 (11.3) | |
IIIA | 81 (38.4) | 20 (33.3) | |
IIIB | 69 (32.7) | 20 (33.3) | |
IIIC | 20 (9.5) | 5 (8.3) | |
Chemoradiation sequence | |||
Concurrent | 191 (90.5) | 32 (51.6) | < 0.001 |
Sequential | 20 (9.5) | 28 (46.7) | |
Thoracic radiation modality | |||
3D-CRT | 191 (90.5) | 51 (85.0) | 0.325 |
IMRT (VMAT) | 20 (9.5) | 9 (15.0) | |
Thoracic radiation total dose (Gy) | 54.0 (43.2–72.0) | 54.0 (30–63) | 0.092 |
Thoracic radiation fractionation | 27 (15–33) | 27 (10–35) | 0.147 |
Chemotherapy regimen | |||
Etoposide and cisplatin | 182 (86.3) | 33 (55.0) | < 0.001 |
Etoposide and carboplatin | 28 (13.3) | 26 (43.3) | |
Irinotecan and cisplatin | 1 (0.5) | 1 (1.7) | |
PCI dose-fractionation scheme | |||
25 Gy/10 fx | 204 (96.7) | - | |
Others | 7 (3.3) | - | |
Response to chemoradiation (RECIST) | |||
Complete response | 32 (15.2) | 4 (6.7) | 0.005 |
Partial response | 158 (74.9) | 41 (68.3) | |
Stable disease | 21 (9.9) | 15 (25.0) |
Values are presented as median (range) or number (%). 3D-CRT, three-dimensional conformal radiation therapy; AJCC, American Joint Committee on Cancer; ECOG, Eastern Cooperative Oncology Group; FEV1, forced expiratory volume in 1 second; FVC, forced vital capacity; IMRT, intensity-modulated radiation therapy; PCI, prophylactic cranial irradiation; RECIST, Response Evaluation Criteria in Solid Tumors; VMAT, volumetric-modulated arc therapy.
Univariate and multivariate analyses of clinical endpoints
Characteristic (comparison vs. reference) | Intracranial recurrence | Extracranial recurrence | ||||||||||
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Univariate | Multivariate | Univariate | Multivariate | |||||||||
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HR | 95% CI | p-value | HR | 95% CI | p-value | HR | 95% CI | p-value | HR | 95% CI | p-value | |
Prophylactic cranial irradiation (yes vs. no) | 0.623 | 0.347–1.121 | 0.114 | 0.657 | 0.362–1.192 | 0.167 | 0.778 | 0.534–1.135 | 0.193 | - | - | - |
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Age (> 70 vs. ≤ 70 yr) | 0.894 | 0.483–1.656 | 0.722 | - | - | - | 1.028 | 0.712–1.485 | 0.883 | - | - | - |
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Sex (male vs. female) | 1.393 | 0.661–2.937 | 0.384 | - | - | - | 1.251 | 0.803–1.950 | 0.322 | - | - | - |
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Smoking (yes vs. no) | 1.722 | 0.782–3.791 | 0.177 | - | - | - | 1.088 | 0.713–1.660 | 0.695 | - | - | - |
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FEV1/FVC (< 70% vs. ≥ 70%) | 1.416 | 0.821–2.442 | 0.211 | - | - | - | 1.133 | 0.816–1.575 | 0.456 | - | - | - |
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ECOG performance status (2–3 vs. 0–1) | 0.905 | 0.283–2.895 | 0.866 | - | - | - | 1.397 | 0.791–2.468 | 0.249 | - | - | - |
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Initial neuron-specific enolase (> 16.3 vs. ≤ 16.3 ng/mL) | 0.928 | 0.511–1.684 | 0.806 | - | - | - | 0.974 | 0.675–1.406 | 0.889 | - | - | - |
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Initial neutrophil-lymphocyte ratio (> 3.53 vs. ≤ 3.53) | 1.879 | 1.045–3.379 | 0.035 | 1.617 | 0.890–2.938 | 0.115 | 1.095 | 0.718–1.671 | 0.674 | - | - | - |
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Disease stage (III vs. I-II) | 1.879 | 0.923–3.824 | 0.082 | 1.845 | 0.892–3.814 | 0.099 | 1.664 | 1.090–2.541 | 0.018 | 1.763 | 1.152–2.696 | 0.009 |
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Chemoradiation sequence (sequential vs. concurrent) | 1.343 | 0.697–2.589 | 0.378 | - | - | - | 1.671 | 1.135–2.459 | 0.009 | 1.512 | 1.009–2.267 | 0.045 |
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Treatment response (SD vs. CR-PR) | 2.358 | 1.270–4.376 | 0.007 | 2.164 | 1.154–4.057 | 0.016 | 2.285 | 1.513–3.450 | < 0.001 | 2.097 | 1.364–3.225 | 0.001 |
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Characteristic (comparison vs. reference) | Progression-free rate | Overall survival | ||||||||||
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Univariate | Multivariate | Univariate | Multivariate | |||||||||
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HR | 95% CI | p-value | HR | 95% CI | p-value | HR | 95% CI | p-value | HR | 95% CI | p-value | |
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Prophylactic cranial irradiation (yes vs. no) | 0.634 | 0.451–0.892 | 0.009 | 0.784 | 0.529–1.163 | 0.227 | 0.707 | 0.503–0.994 | 0.046 | 0.902 | 0.608–1.339 | 0.609 |
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Age (> 70 vs. ≤ 70 yr) | 1.018 | 0.726–1.428 | 0.918 | - | - | - | 1.363 | 0.981–1.893 | 0.065 | 1.398 | 0.982–1.991 | 0.063 |
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Sex (male vs. female) | 1.409 | 0.923–2.151 | 0.112 | - | - | - | 1.409 | 0.923–2.151 | 0.112 | - | - | - |
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Smoking (yes vs. no) | 1.163 | 0.782–1.732 | 0.456 | - | - | - | 1.459 | 0.956–2.227 | 0.080 | 1.170 | 0.757–1.808 | 0.480 |
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FEV1/FVC (< 70% vs. ≥ 70%) | 1.300 | 0.953–1.775 | 0.098 | 1.184 | 0.855–1.640 | 0.309 | 1.491 | 1.092–2.036 | 0.012 | 1.399 | 1.014–1.931 | 0.041 |
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ECOG performance status (2–3 vs. 0–1) | 1.293 | 0.749–2.232 | 0.357 | - | - | - | 1.422 | 0.808–2.504 | 0.223 | - | - | - |
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Initial neuron-specific enolase (> 16.3 vs. ≤ 16.3 ng/mL) | 0.975 | 0.693–1.374 | 0.886 | - | - | - | 0.899 | 0.637–1.270 | 0.546 | - | - | - |
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Initial neutrophil-lymphocyte ratio (> 3.53 vs. ≤ 3.53) | 1.397 | 0.965–2.023 | 0.076 | 1.183 | 0.797–1.756 | 0.404 | 1.256 | 0.860–1.834 | 0.238 | - | - | - |
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Disease stage (III vs. I-II) | 1.766 | 1.192–2.618 | 0.005 | 1.793 | 1.198–2.684 | 0.005 | 1.851 | 1.236–2.772 | 0.003 | 1.931 | 1.278–2.916 | 0.002 |
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Chemoradiation sequence (sequential vs. concurrent) | 1.627 | 1.132–2.339 | 0.009 | 1.498 | 0.980–2.290 | 0.062 | 1.719 | 1.204–2.454 | 0.003 | 1.391 | 0.898–2.157 | 0.140 |
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Treatment response (SD vs. CR-PR) | 2.283 | 1.555–3.354 | < 0.001 | 1.961 | 1.291–2.981 | 0.002 | 2.000 | 1.367–2.925 | < 0.001 | 1.887 | 1.247–2.857 | 0.003 |
CI, confidenceinterval; CR, complete response; ECOG, Eastern Cooperative Oncology Group; FEV1, forced expiratory volume in 1 second; FVC, forced vital capacity; HR, hazard ratio; PR, partial response; SD, stable disease.
Values are presented as median (range) or number (%). 3D-CRT, three-dimensional conformal radiation therapy; AJCC, American Joint Committee on Cancer; ECOG, Eastern Cooperative Oncology Group; FEV1, forced expiratory volume in 1 second; FVC, forced vital capacity; IMRT, intensity-modulated radiation therapy; PCI, prophylactic cranial irradiation; RECIST, Response Evaluation Criteria in Solid Tumors; VMAT, volumetric-modulated arc therapy.
CI, confidenceinterval; CR, complete response; ECOG, Eastern Cooperative Oncology Group; FEV1, forced expiratory volume in 1 second; FVC, forced vital capacity; HR, hazard ratio; PR, partial response; SD, stable disease.