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Abstract：
BACKGROUND: The estimated dose of radiation to immune cells (EDRIC) has been shown to correlate with the overall survival (OS) of patients who receive definitive thoracic radiotherapy. However, the planning target volume (PTV) may be a confounding factor. We assessed the prognostic value of EDRIC for non-small cell lung cancer (NSCLC) in patients who underwent postoperative radiotherapy (PORT) with homogeneous PTV.
METHODS: Patients with NSCLC who underwent PORT between 2004 and 2019 were included. EDRIC was computed as a function of the number of radiation fractions and mean doses to the lungs, heart, and remaining body. The correlations between EDRIC and OS, disease-free survival (DFS), locoregional-free survival (LRFS), and distant metastasis-free survival (DMFS) were analyzed using univariate and multivariate Cox models. Kaplan-Meier analysis was performed to assess the survival difference between low- and high-EDRIC groups.
RESULTS: In total, 345 patients were analyzed. The mean EDRIC was 6.26 Gy. Multivariate analysis showed that higher EDRIC was associated with worse outcomes in terms of OS (hazard ratio [HR] 1.207, P = .007), DFS (HR 1.129, P = .015), LRFS (HR 1.211, P = .002), and DMFS (HR 1.131, P = .057). In the low- and high-EDRIC groups, the 3-year OS was 81.2% and 74.0%, DFS 39.8% and 35.0%, LRFS 70.4% and 60.5%, and DMFS 73.9% and 63.1%, respectively.
CONCLUSIONS: EDRIC is an independent prognostic factor for survival in patients with NSCLC undergoing PORT. Higher doses of radiation to the immune system are associated with tumor progression and poor survival. Organs at risk for the immune system should be considered during radiotherapy planning.
METHODS: Patients with NSCLC who underwent PORT between 2004 and 2019 were included. EDRIC was computed as a function of the number of radiation fractions and mean doses to the lungs, heart, and remaining body. The correlations between EDRIC and OS, disease-free survival (DFS), locoregional-free survival (LRFS), and distant metastasis-free survival (DMFS) were analyzed using univariate and multivariate Cox models. Kaplan-Meier analysis was performed to assess the survival difference between low- and high-EDRIC groups.
RESULTS: In total, 345 patients were analyzed. The mean EDRIC was 6.26 Gy. Multivariate analysis showed that higher EDRIC was associated with worse outcomes in terms of OS (hazard ratio [HR] 1.207, P = .007), DFS (HR 1.129, P = .015), LRFS (HR 1.211, P = .002), and DMFS (HR 1.131, P = .057). In the low- and high-EDRIC groups, the 3-year OS was 81.2% and 74.0%, DFS 39.8% and 35.0%, LRFS 70.4% and 60.5%, and DMFS 73.9% and 63.1%, respectively.
CONCLUSIONS: EDRIC is an independent prognostic factor for survival in patients with NSCLC undergoing PORT. Higher doses of radiation to the immune system are associated with tumor progression and poor survival. Organs at risk for the immune system should be considered during radiotherapy planning.
摘要：
背景：对免疫细胞（EDRIC）的估计放射剂量已被证明与接受明确胸部放疗的患者的总生存期（OS）相关。然而,规划目标量(PTV)可能是一个混杂因素。我们评估了EDRIC对接受同质PTV术后放疗（PORT）的非小细胞肺癌（NSCLC）患者的预后价值。
方法：纳入2004年至2019年接受PORT的NSCLC患者。EDRIC是根据肺部的辐射分数和平均剂量计算的，心,剩下的尸体。EDRIC和OS之间的相关性，无病生存率（DFS），无局部区域生存（LRFS），使用单变量和多变量Cox模型分析无远处转移生存期（DMFS）。进行Kaplan-Meier分析以评估低EDRIC组和高EDRIC组之间的生存差异。
结果：总计，对345例患者进行分析。平均EDRIC为6.26Gy。多变量分析显示，就OS而言，较高的EDRIC与较差的结果相关（风险比[HR]1.207，P=.007），DFS（HR1.129，P=.015），LRFS（HR1.211，P=.002），和DMFS（HR1.131，P=0.057）。在低EDRIC和高EDRIC组中，三年OS分别为81.2%和74.0%，DFS39.8%和35.0%，LRFS70.4%和60.5%，DMFS分别为73.9%和63.1%，分别。
结论：EDRIC是接受PORT的NSCLC患者生存的独立预后因素。对免疫系统的较高剂量的辐射与肿瘤进展和较差的存活率相关。在放射治疗计划期间，应考虑有免疫系统风险的器官。
方法：纳入2004年至2019年接受PORT的NSCLC患者。EDRIC是根据肺部的辐射分数和平均剂量计算的，心,剩下的尸体。EDRIC和OS之间的相关性，无病生存率（DFS），无局部区域生存（LRFS），使用单变量和多变量Cox模型分析无远处转移生存期（DMFS）。进行Kaplan-Meier分析以评估低EDRIC组和高EDRIC组之间的生存差异。
结果：总计，对345例患者进行分析。平均EDRIC为6.26Gy。多变量分析显示，就OS而言，较高的EDRIC与较差的结果相关（风险比[HR]1.207，P=.007），DFS（HR1.129，P=.015），LRFS（HR1.211，P=.002），和DMFS（HR1.131，P=0.057）。在低EDRIC和高EDRIC组中，三年OS分别为81.2%和74.0%，DFS39.8%和35.0%，LRFS70.4%和60.5%，DMFS分别为73.9%和63.1%，分别。
结论：EDRIC是接受PORT的NSCLC患者生存的独立预后因素。对免疫系统的较高剂量的辐射与肿瘤进展和较差的存活率相关。在放射治疗计划期间，应考虑有免疫系统风险的器官。
