| Objective:Retrospective analysis of 18F-FDG PET/CT-guided thorax radiotherapy（TRT）in the treatment of extracranial oligometastatic non-small cell lung cancer（NSCLC）.Methods:Information on patients with stage IV extracranial oligometastatic NSCLC who underwent PET/CT or CT scans between February 2013 and November 2019was analysed.From patients’medical records,we assessed age,sex,smoking history,patient status,tumor size,lymphatic metastases,histological type,primary tumor site,treatment choice,and date of death.Inclusion criteria were patients with extracranial oligometastatic NSCLC with complete medical records who received thorax radiotherapy（TRT）with maintenance therapy or only maintenance therapy.PET/CT or CT was conducted on selected patients within one month before treatment.Patients with major organ dysfunction,more than one primary tumor,unknown metastatic status,multiple metastases（number>5）,malignant pleural effusion,or who underwent targeted therapy or immunotherapy were excluded.Propensity score matching（PSM）was used to create a maintenance chemotherapy alone group,and a thorax radiotherapy（TRT）plus maintenance chemotherapy group,to reduce the effects of selection bias and confounding variables.The PSM function of the IBM SPSS software（IBM Co.,Armonk,NY,USA）was used to estimate the propensity score,and 1:1 nearest neighbor matching was used with a caliper width of 0.02 for PSM.A Chi-square test was used to check the covariate balance of each subgroup before and after PSM.The survival curves of different variables were determined using the Kaplan–Meier method and then checked by a log-rank test.The results are reported as hazard ratios（HRs）and 95%confidence intervals（CIs）.Forest plots were used to describe the subgroup analysis of all the data.From the univariate analysis results,significant variables（P<0.1）were selected and placed in a Cox regression model and then a multivariable analysis,to ensure that significant variables（P<0.05）associated with the prognosis of patients with extracranial oligometastatic NSCLC were identified.Results:Of the 192 patients with extracranial oligometastatic NSCLC included in the study,122 patients were included in the analysis after PSM.Among all patients,the overall survival（OS）rates at one and two years were 41.7%and 15.1%,respectively,with a median survival time of 10.5 months.In univariate analysis,median survival times were better for patients in the PET/CT group than in the CT group,before PSM:16 months vs.6 months（P<0.001）;after PSM:19 months vs.6months（P<0.001）.median survival times were significantly better in the TRT plus maintenance treatment group than in the maintenance treatment alone group,before PSM:13 months vs.8 months,（P<0.001）;after PSM:14 months vs 8 months,（P<0.001）.Further subgroup analysis of patients with extracranial oligometastatic NSCLC in the PET/CT group showed significant differences between the TRT plus maintenance therapy group vs.maintenance therapy alone:before PSM,25 months vs.11 months（P<0.001）;after PSM:27 months vs.11 months（P<0.001）.In contrast,there was no statistical difference in survival between the maintenance therapy alone group vs.the TRT plus maintenance therapy group for patients with CT inspection:before PSM,8 months vs.5 months（P=0.180）;after PSM,7 months vs.5 months（P=0.236）.Multi-factorial analysis showed a statistically significant difference in survival time for patients with extracranial oligometastatic NSCLC in the PET/CT group vs.CT group,before PSM:HR:0.343,95%CI:0.250-0.471,（P<0.001）;after PSM:HR:0.323,95%CI:0.217-0.480,（P<0.001）;There was a statistically significant difference in survival time in the TRT plus maintenance treatment group compared to the maintenance treatment alone group,before PSM:HR:0.624,95%CI:0.464-0.840,（P=0.002）;after PSM,HR:0.569,95%CI:0.385-0.841,（P=0.005）.Conclusion:Compared to patients in the CT group,PET/CT-guided TRT significantly improved the prognosis of patients with stage IV extracranial oligometastatic NSCLC... |
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