Comparative Study On Quality Of Life Of Patients With Lung Cancer After Uniportal And Multiportal Thoracoscopic Lobectomy

Research purpose:The main purpose of this study is to explore the difference of curative effect between early combined radiotherapy and simple targeted therapy on the basis of firstline targeted therapy for patients with oligometastatic NSCLC with EGFR mutation in real clinical treatment practice,and to explore a new treatment model and provide new clinical evidence for the long-term management of patients with oligometastatic NSCLC with EGFR mutatio。Methods:A total of 166 patients with non-small cell lung cancer(NSCLC)with oligometastasis of EGFR mutation(up to 3 metastatic organs,up to 5 metastatic lesions,and positive lymph nodes in the region are not considered metastatic)who met the inclusion criteria were included。The patients were divided into combination treatment group(first-line EGFR-TKIs targeted treatment and early local radiotherapy)and single-target treatment group(only EGFR-TKIs targeted treatment)。The progression-free survival and total survival of patients since targeted treatment were collected。Kaplan-Meier analysis was used to estimate the progression-free survival rate(PFS)and total survival rate(OS)of patients in the two groups,and to compare and analyze the difference of efficacy between the combined treatment group and the target group。Results:1.From 2014 to 2022,a total of 166 patients were enrolled。After excluding patients taking second-generation and third-generation TKI,a total of 102 patients taking first-generation TKI underwent PFS analysis,with a median follow-up time of50.98 months and a 95% confidence interval of 47.3 months to 54.6 months。Among them,48.1%(n=49)received first-line TKI combined with local lesion radiotherapy(combined treatment group),with a median radiotherapy time of 26.7 days and a 95%confidence interval of 17.3 to 36.0 days,51.9%(n=53)only received first-line TKIs targeted therapy(single targeted group),The combination therapy group(median PFS17 months,95% confidence interval 15.0 months to 18.9 months)was significantly longer than the targeted group(median PFS 10 months,95% confidence interval 6.8months to 13.1 months)(p=0.015,HR=0.621,95% confidence interval 0.416 to0.928),A total of 97 patients underwent OS analysis,with a median follow-up time of50.5 months and a 95% confidence interval of 46.9 months to 54.0 months。Among them,48.5%(n=47)received first-line TKI combined with early local lesion radiotherapy(combined treatment group),with a median radiotherapy time of 26.3days and a 95% confidence interval of 16.5 to 36.1 days。51.5%(n=50)only received first-line TKIs targeted therapy(single targeted group),The combination therapy group(median OS 37 months,95% confidence interval 28.0 to 45.9 months)and the targeted group(median OS 24 months,95% confidence interval 14.9 to 33.0 months)(p=0.045,HR 0.618,95% confidence interval 0.382 to 1.001)。2.The median PFS and median OS of patients with intracranial metastasis in the targeted group and the combined treatment group showed no significant difference(p=0.618,p=0.949)。3.Patients with bone metastasis in the PFS and OS combined treatment group were significantly better than those in the target group。The median PFS=18 months vs10 months(p=0.008,HR=0.441,95% CI 0.233 to 0.836),and the median OS=37months vs 20 months(p=0.008,HR=0.359,95% CI 0.161 to 0.802)。4.Overall analysis of patients taking first-generation TKI showed that median PFS 19 deletion mutation vs 21 L858 R mutation=16.0 months vs 11.0 months(p=0.036,HR=0.664,95% CI 0.443-0.995),median OS 19 deletion mutation vs 21 L858 R mutation=28.0 months vs 16.0 months(p=0.012,HR=0.570,95% CI 0.360-0.901).。Analysis of patients in the targeted therapy group showed that median PFS 19 deletion mutation vs 21 L858 R mutation=13.0 months vs 7.0 months(p=0.026,HR=0.543,95% CI 0.309-0.952),median OS 19 deletion mutation vs 21 L858 R mutation=32months vs 23 months(p=0.458,HR=0.776,95% CI 0.396-1.520)。5.Univariate analysis showed that patients’ age,sex,efficacy evaluation after treatment,smoking,intracranial metastasis,multiple organ metastasis,number of metastatic foci,T stage,N stage were not independent predictors of the efficacy of first-line targeted combined early radiotherapy in patients with EGFR positive oligometastatic NSCLC。Conclusions:Early oral TKIs targeted therapy combined with local focus radiotherapy may improve the PFS benefit of patients with EGFR positive oligometastatic NSCLC,and this benefit can be converted into OS benefit。...