Shen Chan, Shih Ya-Chen Tina, Xu Ying, Yao James C
Department of Health Services Research, The University of Texas MD Anderson Cancer Center, Houston, Texas; Department of Biostatistics, The University of Texas MD Anderson Cancer Center, Houston, Texas.
Cancer. 2014 Jul 1;120(13):2039-49. doi: 10.1002/cncr.28653. Epub 2014 Mar 26.
Octreotide long-acting repeatable (LAR) is indicated for the treatment of carcinoid syndrome and diarrhea related to VIPoma, and may delay tumor growth in patients with neuroendocrine tumors (NETs). To the authors' knowledge, the pattern of octreotide LAR use in clinical practice and its impact on survival outcomes has not been well documented.
Using the Surveillance, Epidemiology, and End Results (SEER)-Medicare database, the authors identified patients with NET aged ≥ 65 years who were diagnosed between July 1999 and December 2007. Patients with US Food and Drug Administration-approved indications for octreotide LAR were identified from Medicare claims. Multivariate logistic regression was performed to ascertain factors associated with octreotide LAR use, whereas the Cox proportional hazards model was used to evaluate the impact of octreotide LAR on survival.
Among those with Food and Drug Administration-approved indications, 245 of 4848 patients with distant-stage disease (51%) and 81 of 807 patients with local/regional disease (10%) initiated treatment with octreotide LAR within 6 months of diagnosis. Multivariate logistic regression indicated that among those with distant-stage disease, older age (≥ 80 years vs 65-69 years) (odds ratio [OR], 0.43; 95% confidence interval [95% CI], 0.23-0.81), female sex (OR, 0.62; 95% CI, 0.40-0.97), and living in the South (vs Northeast) (OR, 0.36; 95% CI, 0.18-0.72) were associated with a lower likelihood of using octreotide LAR. The multivariate proportional hazards model showed that octreotide LAR provided a significant 5-year survival benefit for patients with distant-stage disease (hazards ratio, 0.61; P ≤ .001), whereas this survival benefit was not shown for the patients with local/regional stage (hazards ratio, 0.88; P = .563).
The results of this retrospective study suggest a possible survival benefit for the use of octreotide LAR in elderly patients with distant-stage NET with carcinoid syndrome. The results of the current study also suggest that octreotide LAR is underused in this population despite recommended guidelines.
长效可重复注射用奥曲肽（LAR）适用于治疗类癌综合征和与血管活性肠肽瘤相关的腹泻，并且可能延缓神经内分泌肿瘤（NET）患者的肿瘤生长。据作者所知，奥曲肽LAR在临床实践中的使用模式及其对生存结果的影响尚未得到充分记录。
利用监测、流行病学和最终结果（SEER）-医疗保险数据库，作者确定了1999年7月至2007年12月期间诊断出的年龄≥65岁的NET患者。从医疗保险理赔记录中识别出具有美国食品药品监督管理局批准的奥曲肽LAR适应证的患者。进行多因素逻辑回归分析以确定与使用奥曲肽LAR相关的因素，而Cox比例风险模型用于评估奥曲肽LAR对生存的影响。
在具有食品药品监督管理局批准适应证的患者中，4848例远处转移期疾病患者中有245例（51%）和807例局部/区域期疾病患者中有81例（10%）在诊断后6个月内开始使用奥曲肽LAR治疗。多因素逻辑回归分析表明，在远处转移期疾病患者中，年龄较大（≥80岁 vs 65 - 69岁）（比值比[OR]，0.43；95%置信区间[95%CI]，0.23 - 0.81）、女性（OR，0.62；95%CI，0.40 - 0.97）以及居住在南部（与东北部相比）（OR，0.36；95%CI，0.18 - 0.72）与使用奥曲肽LAR的可能性较低相关。多因素比例风险模型显示，奥曲肽LAR为远处转移期疾病患者提供了显著的5年生存获益（风险比，0.61；P≤0.001），而局部/区域期患者未显示出这种生存获益（风险比，0.88；P = 0.563）。
这项回顾性研究的结果表明，对于患有类癌综合征的老年远处转移期NET患者，使用奥曲肽LAR可能具有生存获益。当前研究结果还表明，尽管有推荐指南，但该人群中奥曲肽LAR的使用不足。
