Division of Cancer Care and Epidemiology, Queen's University Cancer Research Institute, Kingston, Canada.
J Thorac Oncol. 2012 Mar;7(3):559-66. doi: 10.1097/JTO.0b013e31823f43af.
Adjuvant chemotherapy (ACT) is known to improve survival in patients with early-stage non-small cell lung cancer. Herein, we describe chemotherapy regimens used, dose modifications, survival, and treatment-related toxicity in the general population.
All cases of non-small cell lung cancer diagnosed in Ontario in the period 2004-2006 who underwent surgical resection (n = 3354) were identified using the Ontario Cancer Registry in this population-based retrospective cohort study. We linked electronic records of treatment to the registry to identify all cases treated with ACT (n = 1032) and describe drugs, regimens, and dosages delivered. As a proxy measure of ACT-related toxicity, we evaluated deaths and hospitalizations within 16 weeks of starting ACT. Factors associated with dose modification were evaluated by logistic regression. The Cox proportional hazards model was used to describe associations between patient-, disease-, and treatment-related factors and survival.
ACT regimens were identified for 584 of 1032 ACT cases. Almost all cases included cisplatin- or carboplatin-based regimens (478/584, 82%, and 99/584, 17%, respectively). The most common regimen was a vinroelbine/cisplatin doublet (412/584, 71%); 64% of these cases had a dose reduction or omission. Dose modification was not associated with inferior survival on multivariate analysis. Twelve percent of all ACT cases were admitted to hospital within 16 weeks of starting ACT, and there was a 1.6% death rate potentially attributable to ACT. Survival of all ACT cases was comparable with outcomes reported in clinical trials.
ACT regimens used, toxicity, and survival outcomes in the general population are comparable with those reported in clinical trials. Dose modifications used in clinical practice are not associated with inferior survival.
辅助化疗（ACT）已知可提高早期非小细胞肺癌患者的生存率。在此，我们描述了在普通人群中使用的化疗方案、剂量调整、生存和与治疗相关的毒性。
在这项基于人群的回顾性队列研究中，我们使用安大略癌症登记处在 2004-2006 年期间确定了在安大略省接受手术切除的所有非小细胞肺癌病例（n=3354）。我们将电子治疗记录与该登记处链接，以确定所有接受 ACT 治疗的病例（n=1032），并描述所使用的药物、方案和剂量。作为 ACT 相关毒性的替代指标，我们评估了开始 ACT 后 16 周内的死亡和住院情况。通过逻辑回归评估了剂量调整的相关因素。使用 Cox 比例风险模型描述了患者、疾病和治疗相关因素与生存之间的关系。
在 1032 例 ACT 病例中，确定了 584 例 ACT 方案。几乎所有病例均包含顺铂或卡铂为基础的方案（478/584，82%和 99/584，17%）。最常见的方案是长春瑞滨/顺铂的二联方案（412/584，71%）；其中 64%的病例剂量减少或遗漏。多变量分析显示，剂量调整与生存预后较差无关。所有 ACT 病例中，有 12%在开始 ACT 后 16 周内住院，有 1.6%的死亡率可能与 ACT 有关。所有 ACT 病例的生存情况与临床试验报告的结果相当。
普通人群中使用的 ACT 方案、毒性和生存结果与临床试验报告的结果相当。临床实践中使用的剂量调整与较差的生存无关。
