Cargando…
Significance of overall concurrent chemoradiotherapy duration on survival outcomes of stage IIIB/C non-small-cell lung carcinoma patients: Analysis of 956 patients
BACKGROUND: To investigate the detrimental effects of prolonged overall radiotherapy duration (ORTD) on survival outcomes of stage IIIB/C NSCLC patients treated with concurrent chemoradiotherapy (C-CRT) METHODS: The study cohort consisted of 956 patients who underwent C-CRT for stage IIIB/C NSCLC. P...
Autores principales: | , , , , , , |
---|---|
Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
Public Library of Science
2019
|
Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6645460/ https://www.ncbi.nlm.nih.gov/pubmed/31329602 http://dx.doi.org/10.1371/journal.pone.0218627 |
_version_ | 1783437464806883328 |
---|---|
author | Topkan, Erkan Ozdemir, Yurday Kucuk, Ahmet Besen, Ali Ayberk Mertsoylu, Huseyin Sezer, Ahmet Selek, Ugur |
author_facet | Topkan, Erkan Ozdemir, Yurday Kucuk, Ahmet Besen, Ali Ayberk Mertsoylu, Huseyin Sezer, Ahmet Selek, Ugur |
author_sort | Topkan, Erkan |
collection | PubMed |
description | BACKGROUND: To investigate the detrimental effects of prolonged overall radiotherapy duration (ORTD) on survival outcomes of stage IIIB/C NSCLC patients treated with concurrent chemoradiotherapy (C-CRT) METHODS: The study cohort consisted of 956 patients who underwent C-CRT for stage IIIB/C NSCLC. Primary endpoint was the association between the ORTD and overall survival (OS) with locoregional progression-free survival (LRPFS) and PFS comprising the secondary endpoints. Receiver operating characteristic (ROC) curve analysis was utilized for accessibility of the cut-off that interacts with survival outcomes. Multivariate Cox model was utilized to identify the independent associates of survival outcomes. RESULTS: The ROC curve analysis exhibited significance at 49 days of ORTD cut-off that dichotomized patients into ORTD<50 versus ORTD≥50 days groups for OS [area under the curve (AUC): 82.8%; sensitivity: 81.1%; specificity: 74.8%], LRPFS (AUC: 91.9%; sensitivity: 90.6%; specificity: 76.3%), and PFS (AUC: 76.1%; sensitivity: 72.4%; specificity: 68.2%), respectively. Accordingly, ORTD≥50 days group had significantly shorter median OS (P<0.001), LRPFS (P<0.001), and PFS (P<0.001); and 10-year actuarial locoregional control (P<0.001) and distant metastases-free (P<0.011) rates than the ORTD<50 days group. The ORTD retained its significant association with survival outcomes at multivariate analyses independent of the other favorable covariates (p<0.001, for OS, LRPFS, and PFS): Stage IIIB disease (versus IIIC), lymph node bulk <2 cm (versus ≥2 cm), and 2–3 chemotherapy cycles (versus 1). The higher sensitivity for LRPFS (90.6%) than PFS (72.4%) on ROC curve analysis suggested the prolonged ORTD-induced decrements in locoregional control rates as the major cause of the poor survival outcomes. CONCLUSIONS: Longer ORTD beyond ≥50 days was associated with significantly poorer OS, LRPFS and PFS outcomes, where reduced locoregional control rates appeared to be the main causative. |
format | Online Article Text |
id | pubmed-6645460 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2019 |
publisher | Public Library of Science |
record_format | MEDLINE/PubMed |
spelling | pubmed-66454602019-07-25 Significance of overall concurrent chemoradiotherapy duration on survival outcomes of stage IIIB/C non-small-cell lung carcinoma patients: Analysis of 956 patients Topkan, Erkan Ozdemir, Yurday Kucuk, Ahmet Besen, Ali Ayberk Mertsoylu, Huseyin Sezer, Ahmet Selek, Ugur PLoS One Research Article BACKGROUND: To investigate the detrimental effects of prolonged overall radiotherapy duration (ORTD) on survival outcomes of stage IIIB/C NSCLC patients treated with concurrent chemoradiotherapy (C-CRT) METHODS: The study cohort consisted of 956 patients who underwent C-CRT for stage IIIB/C NSCLC. Primary endpoint was the association between the ORTD and overall survival (OS) with locoregional progression-free survival (LRPFS) and PFS comprising the secondary endpoints. Receiver operating characteristic (ROC) curve analysis was utilized for accessibility of the cut-off that interacts with survival outcomes. Multivariate Cox model was utilized to identify the independent associates of survival outcomes. RESULTS: The ROC curve analysis exhibited significance at 49 days of ORTD cut-off that dichotomized patients into ORTD<50 versus ORTD≥50 days groups for OS [area under the curve (AUC): 82.8%; sensitivity: 81.1%; specificity: 74.8%], LRPFS (AUC: 91.9%; sensitivity: 90.6%; specificity: 76.3%), and PFS (AUC: 76.1%; sensitivity: 72.4%; specificity: 68.2%), respectively. Accordingly, ORTD≥50 days group had significantly shorter median OS (P<0.001), LRPFS (P<0.001), and PFS (P<0.001); and 10-year actuarial locoregional control (P<0.001) and distant metastases-free (P<0.011) rates than the ORTD<50 days group. The ORTD retained its significant association with survival outcomes at multivariate analyses independent of the other favorable covariates (p<0.001, for OS, LRPFS, and PFS): Stage IIIB disease (versus IIIC), lymph node bulk <2 cm (versus ≥2 cm), and 2–3 chemotherapy cycles (versus 1). The higher sensitivity for LRPFS (90.6%) than PFS (72.4%) on ROC curve analysis suggested the prolonged ORTD-induced decrements in locoregional control rates as the major cause of the poor survival outcomes. CONCLUSIONS: Longer ORTD beyond ≥50 days was associated with significantly poorer OS, LRPFS and PFS outcomes, where reduced locoregional control rates appeared to be the main causative. Public Library of Science 2019-07-22 /pmc/articles/PMC6645460/ /pubmed/31329602 http://dx.doi.org/10.1371/journal.pone.0218627 Text en © 2019 Topkan et al http://creativecommons.org/licenses/by/4.0/ This is an open access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/4.0/) , which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. |
spellingShingle | Research Article Topkan, Erkan Ozdemir, Yurday Kucuk, Ahmet Besen, Ali Ayberk Mertsoylu, Huseyin Sezer, Ahmet Selek, Ugur Significance of overall concurrent chemoradiotherapy duration on survival outcomes of stage IIIB/C non-small-cell lung carcinoma patients: Analysis of 956 patients |
title | Significance of overall concurrent chemoradiotherapy duration on survival outcomes of stage IIIB/C non-small-cell lung carcinoma patients: Analysis of 956 patients |
title_full | Significance of overall concurrent chemoradiotherapy duration on survival outcomes of stage IIIB/C non-small-cell lung carcinoma patients: Analysis of 956 patients |
title_fullStr | Significance of overall concurrent chemoradiotherapy duration on survival outcomes of stage IIIB/C non-small-cell lung carcinoma patients: Analysis of 956 patients |
title_full_unstemmed | Significance of overall concurrent chemoradiotherapy duration on survival outcomes of stage IIIB/C non-small-cell lung carcinoma patients: Analysis of 956 patients |
title_short | Significance of overall concurrent chemoradiotherapy duration on survival outcomes of stage IIIB/C non-small-cell lung carcinoma patients: Analysis of 956 patients |
title_sort | significance of overall concurrent chemoradiotherapy duration on survival outcomes of stage iiib/c non-small-cell lung carcinoma patients: analysis of 956 patients |
topic | Research Article |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6645460/ https://www.ncbi.nlm.nih.gov/pubmed/31329602 http://dx.doi.org/10.1371/journal.pone.0218627 |
work_keys_str_mv | AT topkanerkan significanceofoverallconcurrentchemoradiotherapydurationonsurvivaloutcomesofstageiiibcnonsmallcelllungcarcinomapatientsanalysisof956patients AT ozdemiryurday significanceofoverallconcurrentchemoradiotherapydurationonsurvivaloutcomesofstageiiibcnonsmallcelllungcarcinomapatientsanalysisof956patients AT kucukahmet significanceofoverallconcurrentchemoradiotherapydurationonsurvivaloutcomesofstageiiibcnonsmallcelllungcarcinomapatientsanalysisof956patients AT besenaliayberk significanceofoverallconcurrentchemoradiotherapydurationonsurvivaloutcomesofstageiiibcnonsmallcelllungcarcinomapatientsanalysisof956patients AT mertsoyluhuseyin significanceofoverallconcurrentchemoradiotherapydurationonsurvivaloutcomesofstageiiibcnonsmallcelllungcarcinomapatientsanalysisof956patients AT sezerahmet significanceofoverallconcurrentchemoradiotherapydurationonsurvivaloutcomesofstageiiibcnonsmallcelllungcarcinomapatientsanalysisof956patients AT selekugur significanceofoverallconcurrentchemoradiotherapydurationonsurvivaloutcomesofstageiiibcnonsmallcelllungcarcinomapatientsanalysisof956patients |