Background/Objectives:Despite advancements in treatment for patients with unresectable locally advanced non-small cell lung cancer (LA-NSCLC), overall survival (OS) remains poor. The specific effects of varying heart and lung doses on OS in LA-NSCLC patients have not been thoroughly investigated, especially their combined impact on survival. This study aimed to examine the impact on OS of both individual and combined heart and lung doses in patients with LA-NSCLC treated with radiotherapy over a three-year follow-up period.Methods:A total of 120 patients who received definitive radiotherapy for LA-NSCLC (stage III, 92.5%) from January 2015 to January 2020 were retrospectively reviewed. The endpoint in this study was OS. Each patient was followed for a fixed period of three years.Results:Univariate Cox regression analysis showed that OS was significantly related to mean heart dose (MHD, hazard ratio [HR], 3.4 [1.8–6.3];p< 0.001), pericardium V40 (HR, 3.2 [1.7–6.0];p< 0.001), and total lung V20 (HR, 2.6 [1.4–5.0];p= 0.003), and these were independent predictors for worse OS in multivariate analysis. Kaplan–Meier curve analysis with log-rank tests revealed that survival was significantly worse in patients with higher MHD (p< 0.001), pericardium V40 (p< 0.001), and total lung V20 (p= 0.002). Combining MHD and total lung V20, and pericardium V40 and total lung V20 provided enhanced risk stratification for OS (p< 0.001 for both combinations).Conclusions:The combination of heart and lung doses provided enhanced and more detailed risk stratification in prediction of OS for a fixed period of three years in LA-NSCLC patients treated with radiotherapy.
背景/目的：尽管不可切除局部晚期非小细胞肺癌（LA-NSCLC）患者的治疗已取得进展，但其总生存期（OS）仍然较差。心脏与肺部不同剂量对LA-NSCLC患者OS的具体影响尚未得到深入研究，尤其是二者对生存期的联合影响。本研究旨在探讨放疗治疗的LA-NSCLC患者中，心脏与肺部剂量单独及联合对三年随访期内OS的影响。 方法：回顾性分析了2015年1月至2020年1月期间接受根治性放疗的120例LA-NSCLC患者（III期占92.5%）。本研究的主要终点为OS。每位患者均接受为期三年的固定随访。 结果：单变量Cox回归分析显示，OS与平均心脏剂量（MHD，风险比[HR]为3.4 [1.8–6.3]；p < 0.001）、心包V40（HR为3.2 [1.7–6.0]；p < 0.001）和全肺V20（HR为2.6 [1.4–5.0]；p = 0.003）显著相关，且在多变量分析中这些均为OS较差的独立预测因子。Kaplan–Meier曲线分析及对数秩检验显示，MHD较高（p < 0.001）、心包V40较高（p < 0.001）和全肺V20较高（p = 0.002）的患者生存期显著更差。联合MHD与全肺V20，以及心包V40与全肺V20，可提供增强的OS风险分层（两种组合的p值均< 0.001）。 结论：在放疗治疗的LA-NSCLC患者中，心脏与肺部剂量的联合应用为三年固定期内的OS预测提供了增强且更详细的风险分层。
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