Jordá Aragón Carlos, Peñalver Cuesta Juan Carlos, Mancheño Franch Nuria, de Aguiar Quevedo Karol, Vera Sempere Francisco, Padilla Alarcón José
Servicio de Cirugía Torácica, Hospital Universitario y Politécnico La Fe, Valencia, España.
Servicio de Cirugía Torácica, Instituto Valenciano de Oncología, Valencia, España.
Med Clin (Barc). 2015 Sep 7;145(5):185-91. doi: 10.1016/j.medcli.2014.07.032. Epub 2014 Nov 26.
Survival studies of non-small cell lung cancer (NSCLC) are usually based on the Kaplan-Meier method. However, other factors not covered by this method may modify the observation of the event of interest. There are models of cumulative incidence (CI), that take into account these competing risks, enabling more accurate survival estimates and evaluation of the risk of death from other causes. We aimed to evaluate these models in resected early-stage NSCLC patients.
This study included 263 patients with resected NSCLC whose diameter was ≤ 3 cm without node involvement (N0). Demographic, clinical, morphopathological and surgical variables, TNM classification and long-term evolution were analysed. To analyse CI, death by another cause was considered to be competitive event. For the univariate analysis, Gray's method was used, while Fine and Gray's method was employed for the multivariate analysis.
Mortality by NSCLC was 19.4% at 5 years and 14.3% by another cause. Both curves crossed at 6.3 years, and probability of death by another cause became greater from this point. In multivariate analysis, cancer mortality was conditioned by visceral pleural invasion (VPI) (P=.001) and vascular invasion (P=.020), with age>50 years (P=.034), smoking (P=.009) and the Charlson index ≥ 2 (P=.000) being by no cancer.
By the method of CI, VPI and vascular invasion conditioned cancer death in NSCLC >3 cm, while non-tumor causes of long-term death were determined.
非小细胞肺癌（NSCLC）的生存研究通常基于Kaplan-Meier方法。然而，该方法未涵盖的其他因素可能会改变对感兴趣事件的观察。有累积发病率（CI）模型，其考虑了这些竞争风险，能够更准确地估计生存率并评估其他原因导致的死亡风险。我们旨在评估这些模型在接受手术切除的早期NSCLC患者中的应用。
本研究纳入了263例直径≤3 cm且无淋巴结转移（N0）的接受手术切除的NSCLC患者。分析了人口统计学、临床、形态病理学和手术变量、TNM分类以及长期演变情况。为分析CI，将其他原因导致的死亡视为竞争事件。单因素分析采用Gray方法，多因素分析采用Fine和Gray方法。
NSCLC导致的5年死亡率为19.4%，其他原因导致的死亡率为14.3%。两条曲线在6.3年时相交，从这一点起，其他原因导致的死亡概率变得更高。在多因素分析中，癌症死亡率受脏层胸膜侵犯（VPI）（P = 0.001）和血管侵犯（P = 0.020）影响，而年龄>50岁（P = 0.034）、吸烟（P = 0.009）和Charlson指数≥2（P = 0.000）则与非癌症因素有关。
通过CI方法，VPI和血管侵犯影响了直径>3 cm的NSCLC患者的癌症死亡，同时确定了长期死亡的非肿瘤原因。
