Objective To compare the efficacy of sequential chemoradiotherapy and concurrent chemoradiotherapy in treatment of advanced lung cancer and analyze influencing factors of prognosis.
Methods Ninety-six patients with advanced lung cancer were selected as study subjects and randomly divided into control group and observation group, with 48 patients in each group. The control group received sequential chemoradiotherapy, while the observation group received concurrent chemoradiotherapy. The levels of epidermal growth factor receptor (EGFR) and Karnofsky Performance Status (KPS) were compared between the two groups before and after treatment. Additionally, the short-term efficacy, progression-free survival (PFS), overall survival (OS), and 1-year survival rate were compared between the two groups. Based on prognostic survival, the patients were divided into survival group (n=64) and death group (n=32). The Cox regression model was used to analyze the prognostic factors in patients with advanced lung cancer, and a receiver operating characteristic (ROC) curve was plotted to evaluate the predictive efficacy of combined indicators.
Results The objective response rate and disease control rate in the observation group were 60.42% and 87.50%, respectively, which were significantly higher than 35.42% and 60.42% in the control group (P < 0.05). After treatment, the EGFR level in the observation groupwas lower than that in the control group, while the KPS was higher (P < 0.05). The PFS and OS in the observation group were longer than those in the control group, and the 1-year survival rate was higher (P < 0.05). Significant differences were observed between the survival and death groups in terms of concurrent brain metastases, pre-treatment EGFR level, pre-treatment KPS, and treatment modality (P < 0.05). Multivariate Cox regression analysis revealed that concurrent brain metastases, pre-treatment EGFR level, and treatmentmodality were independent prognostic factors for patients with advanced lung cancer (P < 0.05). The ROC curve analysis showed that the area under the curve for the combination of concurrent brain metastases, pre-treatment EGFR level, and treatment modality in predicting the prognosis of patients with advanced lung cancer was 0.804, with a sensitivity of 0.688 and a specificity of 0.844.
Conclusion Compared with sequential chemoradiotherapy, concurrent chemoradiotherapy is more effective in treatment of advanced lung cancer, thereby reducing EGFR levels, prolonging PFS and OS, and improving KPS and 1-year survival rate. Concurrent brain metastases, pre-treatment EGFR level, and treatment modality are independent prognostic factors, and their combination has a good predictive efficacy for prognosis.
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