Department of Clinical Epidemiology, VieCuri Medical Centre, Venlo; Department of Epidemiology, Maastricht University Medical Center, GROW School for Oncology and Developmental Biology, Maastricht.
Department of Research, Comprehensive Cancer Centre The Netherlands, Eindhoven, The Netherlands.
Ann Oncol. 2015 May;26(5):902-907. doi: 10.1093/annonc/mdv061. Epub 2015 Feb 11.
Many patients with non-small cell lung cancer (NSCLC) die within the first few years of diagnosis, and considerable excess mortality remains even after 5 years. We investigated the death rate and the distribution of causes of death for NSCLC patients by age and stage at diagnosis during long-term follow-up.
All 72 021 patients aged 45-89 years diagnosed with stage I-III NSCLC between 1989 and 2008 in the Netherlands and who died up till 2011 were derived from the Netherlands Cancer Registry and linked with the database of Statistics Netherlands for underlying causes of death. Mortality ratios and proportional distribution of causes of death were calculated during 5 time periods after diagnosis of NSCLC (up to 15 years).
Median follow-up was 9.6 years (range: 0-23 years). Lung cancer was the predominant cause of death in the first 6 years after diagnosis (being 80%-85% and ∼90% up to 3 years for localized and locally advanced disease, respectively, and ∼60%-75% and ∼75%-85% during years 4-6 for both stage groups, respectively). Thereafter, lung cancer as cause of death proportionally decreased with time since diagnosis, but remained over 30%. Hence, cardiovascular diseases and chronic obstructive pulmonary diseases (COPD) became more important causes of death, especially for patients aged >60 years at diagnosis (up to 34% for cardiovascular diseases and up to 19% for COPD).
With time, the relative contribution of cardiovascular and COPD causes of death increased, although the absolute contribution of lung cancer remained high in non-metastatic NSCLC. Therefore, managing morbidity of these diseases remains relevant.
许多非小细胞肺癌（NSCLC）患者在诊断后的头几年内死亡，即使在 5 年后仍存在相当大的超额死亡率。我们通过长期随访研究了不同年龄和诊断时分期的 NSCLC 患者的死亡率和死因分布。
所有年龄在 45-89 岁、1989 年至 2008 年间在荷兰诊断为 I-III 期 NSCLC 的 72021 例患者，以及截止到 2011 年已死亡的患者，均来源于荷兰癌症登记处，并与荷兰统计局的潜在死因数据库相链接。在 NSCLC 诊断后的 5 个时间段（最长 15 年）计算死亡率比和死因比例分布。
中位随访时间为 9.6 年（范围：0-23 年）。肺癌是诊断后前 6 年内死亡的主要原因（局限性和局部晚期疾病分别为 80%-85%和 ∼90%，两个分期组分别为 4-6 年期间为 ∼60%-75%和 ∼75%-85%）。此后，随着诊断后时间的推移，肺癌作为死因的比例逐渐下降，但仍超过 30%。因此，心血管疾病和慢性阻塞性肺疾病（COPD）成为更重要的死因，特别是对于诊断时年龄大于 60 岁的患者（心血管疾病高达 34%，COPD 高达 19%）。
随着时间的推移，心血管和 COPD 死因的相对贡献增加，尽管非转移性 NSCLC 中肺癌的绝对贡献仍然很高。因此，管理这些疾病的发病率仍然很重要。
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