Department of Pathology, Texas Tech University Health Sciences Center, Lubbock, TX 79430-8312, USA.
J Surg Res. 2012 May 1;174(1):20-3. doi: 10.1016/j.jss.2011.06.051. Epub 2011 Jul 22.
In October 2006, bevacizumab was approved for treatment for patients with metastatic non-small-cell lung cancer other than squamous carcinoma. Our hypothesis was that the change in survival after approval of bevacizumab for metastatic adenocarcinoma would show differences from that of small-cell carcinoma and squamous carcinoma.
Data was obtained from the National Cancer Institute Surveillance Epidemiology and End Results (SEER) registry for patients with lung cancer diagnosed between January 2004 and November 2007. In addition to known characteristics predicting survival differences (histotype, age, gender, and race) we compared 1-year survival experience in those diagnosed before (January 2004-September 2006) and after (October 2006-November 2007) introduction of bevacizumab.
Of 24,575 patients meeting criteria, 16,081 (65.4%) died within 1 y. Adjusted for age, gender, and race, patients with squamous carcinoma showed a 13% decline (95% CI 7%-20%) in survival times. By contrast, the 1% increment for adenocarcinoma and the 1% decrement for small cell carcinoma might well have been due to chance (P > 0.05 for each analysis).
Life expectancy for metastatic adenocarcinoma (for which bevacizumab is approved) and metastatic small-cell carcinoma (bevacizumab not approved) did not change statistically. On the other hand, life expectancy for patients with metastatic squamous carcinoma (bevacizumab not approved) of the lung has declined since the approval of bevacizumab. This likely reflects increased classification of tumors previously diagnosed as poorly differentiated non-small-cell carcinoma as poorly differentiated squamous carcinoma. Hence, life expectancy of metastatic adeno, squamous, and small-cell-lung cancer has not improved after introduction of bevacizumab.
2006 年 10 月，贝伐单抗被批准用于治疗非鳞状非小细胞肺癌转移患者。我们的假设是，贝伐单抗批准用于治疗转移性腺癌后的生存变化将与小细胞癌和鳞状细胞癌有所不同。
从国家癌症研究所监测、流行病学和最终结果（SEER）登记处获取了 2004 年 1 月至 2007 年 11 月期间诊断为肺癌的患者数据。除了已知的预测生存差异的特征（组织类型、年龄、性别和种族）外，我们还比较了在贝伐单抗引入之前（2004 年 1 月至 2006 年 9 月）和之后（2006 年 10 月至 2007 年 11 月）诊断的患者的 1 年生存率。
在符合条件的 24575 名患者中，16081 名（65.4%）在 1 年内死亡。调整年龄、性别和种族后，鳞状细胞癌患者的生存时间下降了 13%（95%CI7%-20%）。相比之下，腺癌的 1%增长和小细胞癌的 1%下降很可能是由于偶然因素（每种分析的 P>0.05）。
转移性腺癌（贝伐单抗批准用于治疗）和转移性小细胞癌（贝伐单抗未批准用于治疗）的预期寿命没有统计学上的变化。另一方面，自贝伐单抗批准以来，肺转移性鳞状细胞癌（贝伐单抗未批准用于治疗）患者的预期寿命已经下降。这可能反映出先前诊断为低分化非小细胞癌的肿瘤被更多地归类为低分化鳞状细胞癌。因此，引入贝伐单抗后，转移性腺癌、鳞状细胞癌和小细胞肺癌的预期寿命没有改善。
