Stevens Wendy, Stevens Graham, Kolbe John, Cox Brian
Discipline of Oncology, University of Auckland, Auckland, New Zealand.
J Thorac Oncol. 2007 Jun;2(6):481-93. doi: 10.1097/JTO.0b013e31805fea3a.
The survival of patients with lung cancer in New Zealand is poor compared with Australia and the United States. To determine whether these poorer outcomes were related to secondary care management or to other factors, we documented stage of disease, comorbidities, and initial secondary care management for patients diagnosed with lung cancer in 2004, in Auckland and Northland (New Zealand). These data were compared with international data.
Cases were identified from regional databases and the New Zealand Cancer Registry. Patient, tumor, and management details were collected from clinical records.
Five hundred sixty-five eligible cases were identified: 55% were male, the median age was 69 years, 9% were never-smokers, 81% had documented comorbidity, and 32% belonged to the most deprived socioeconomic quintile. Histopathology was non-small cell lung cancer (NSCLC) in 70%, small-cell lung cancer (SCLC) in 13%, 2% other types, and 15% clinicoradiological diagnoses. At presentation, 70% of NSCLC cases had locally advanced/metastatic disease, and 65% of SCLC cases had extensive disease. Overall, 70% of cases were referred to an anticancer service, and 50% received initial anticancer treatment. Potentially curative treatment was received by 20% of cases: 56% stage I/II, 10% stage III NSCLC, and 58% limited-stage SCLC.
This cohort was characterized by high comorbidity and advanced disease. Although similar to the United Kingdom, initial treatment rates were low in comparison with Australia and the United States, despite similar stage distributions. Overall, 50% of patients, including 30% with early-stage disease, did not receive initial anticancer treatment. Low anticancer treatment rates may contribute to poorer survival outcomes in New Zealand.
与澳大利亚和美国相比，新西兰肺癌患者的生存率较低。为了确定这些较差的治疗结果是与二级医疗管理还是其他因素有关，我们记录了2004年在奥克兰和北地（新西兰）被诊断为肺癌的患者的疾病分期、合并症以及初始二级医疗管理情况。这些数据与国际数据进行了比较。
从区域数据库和新西兰癌症登记处识别病例。从临床记录中收集患者、肿瘤和管理细节。
共识别出565例符合条件的病例：55%为男性，中位年龄为69岁，9%为从不吸烟者，81%有合并症记录，32%属于社会经济最贫困的五分之一人群。组织病理学诊断为非小细胞肺癌（NSCLC）的占70%，小细胞肺癌（SCLC）的占13%，其他类型的占2%，临床放射学诊断的占15%。就诊时，70%的NSCLC病例有局部晚期/转移性疾病，65%的SCLC病例有广泛疾病。总体而言，70%的病例被转诊至抗癌服务机构，50%接受了初始抗癌治疗。20%的病例接受了潜在的根治性治疗：I/II期为56%，III期NSCLC为10%，局限期SCLC为58%。
该队列的特点是合并症多且疾病进展。尽管与英国相似，但与澳大利亚和美国相比，初始治疗率较低，尽管分期分布相似。总体而言，50%的患者，包括30%的早期疾病患者，未接受初始抗癌治疗。抗癌治疗率低可能导致新西兰患者的生存结果较差。
