目的:回顾分析伴恶性胸腔积液(MPE)的非小细胞肺癌(NSCLC)原发灶放疗相关因素对生存影响。方法:2007—2019年间经病理学证实、初治的伴MPE的NSCLC共256例，其中117例纳入分析。按放疗剂量<63 Gy与≥63 Gy分为2个组，采用倾向性评分匹配法均衡组间混杂因素(卡钳值＝0.1)。n Kaplan-n Meier法计算生存并log-rank单因素分析，n Cox模型多因素分析放疗相关因素对总生存(OS)影响。n 结果:原发灶放疗可延长OS(n P<0.001)，且随剂量36.0～44.1 Gy、45.0～62.1 Gy、63.0～71.1 Gy提高OS延长(n P<0.001)，中位生存期分别为5、13、18个月。匹配前单因素分析显示原发灶剂量≥63 Gy、大体肿瘤体积<157.7 cmn 3、引流区淋巴结转移≤5站的OS延长(均n P<0.05)，Tn 4Nn 3期较其他期患者OS降低(n P＝0.018)；匹配后单因素分析显示原发灶剂量≥63 Gy的OS仍延长(n P＝0.013)，≤5站引流区淋巴结转移OS呈延长趋势(n P＝0.098)。匹配前多因素分析显示原发灶放疗剂量≥63 Gy是延长生存的独立预后因素(n HR＝0.566，95%n CI为0.368～0.871，n P＝0.010)，GTV<157.7 cmn 3有延长OS趋势(n HR＝0.679，95%n CI为0.450～1.024，n P＝0.065)；匹配后多因素分析显示原发灶放疗剂量≥63 Gy仍是延长生存的独立预后因素(n HR＝0.547，95%n CI为0.333～0.899，n P＝0.017)。3级急性放射性食管炎和放射性肺炎分别为9.4%、5.1%，无≥4级不良反应。n 结论:MPE-NSCLC在胸腔积液可控的前提下，原发灶放疗剂量对延长OS可能起关键作用。“,”Objective:To analyze the radiotherapy-related factors affecting the survival of non-small cell lung cancer (NSCLC) patients complicated with malignant pleural effusion (MPE)(MPE-NSCLC).Methods:From 2007 to 2019, 256 patients pathologically diagnosed with MPE-NSCLC received primary treatment. Among them, 117 cases were enrolled in this study. All patients were divided into two groups according to the radiation dose (<63 Gy and≥63 Gy). Propensity score matching (PSM) was performed to further adjust the confounding factors (Calipers value=0.1). The impact of radiotherapy-related factors on the overall survival (OS) was analyzed by Kaplan—Meier method, log-rank test andn Cox’s regression model.n Results:Primary tumor radiotherapy significantly prolonged the OS (n P<0.001). The radiation dose escalation (36.0-44.1 Gy, 45.0-62.1 Gy, 63.0-71.1 Gy) of primary tumor significantly prolonged the OS (n P<0.001). The corresponding median OS were 5, 13 and 18 months, respectively. Before the PSM, univariate analysis suggested that radiation dose ≥63 Gy, gross tumor volume (GTV)<157.7 cmn 3 and stations of metastatic lymph node (S-mlN)≤5 were significantly associated with better OS (all n P<0.05) and Tn 4Nn 3 was significantly associated with worse OS (n P=0.018). After the PSM, univariate analysis indicated that radiation dose ≥63 Gy was significantly associated with better OS (n P=0.013) and S-mlN ≤5 had a tendency to prolong the OS (n P=0.098). Prior to the PSM, multivariate analysis showed that radiation dose ≥63 Gy was an independent favorable factor of OS (n HR=0.566, 95%n CI 0.368-0.871, n P=0.010) and GTV<157.7 cmn 3 had a tendency to prolong the OS (n HR=0.679, 95%n CI 0.450-1.024, n P=0.065). After the PSM, multivariate analysis revealed that radiation dose ≥63 Gy was still an independent favorable factor of OS (n HR=0.547, 95%n CI 0.333~0.899, n P=0.017). No ≥grade 4 radiation toxicity occurred. The incidence rates of grade 3 radiation esophagitis and pneumonitis were 9.4% and 5.1%, respectively.n Conclusion:For MPE-NSCLC, radiotherapy dose of primary tumor may play a key role in improving OS on the basis of controllable MPE.