Division of Oncology-Hematology, Department of Internal Medicine, VA Nebraska-Western Iowa Health Care System, University of Nebraska Medical Center, Omaha, Nebraska.
Division of Hematology-Oncology, Medical Service, Durham VA Medical Center, Durham, North Carolina.
Cancer. 2015 Aug 1;121(15):2578-85. doi: 10.1002/cncr.29360. Epub 2015 Apr 14.
Adjuvant chemotherapy after surgical resection improves outcomes for patients with early-stage non-small cell lung cancer (NSCLC). To the authors' knowledge, there are no published prospective trials to date of adjuvant chemotherapy after surgical resection administered exclusively in older patients. In the current study, the authors sought to evaluate the efficacy of adjuvant chemotherapy in older patients in a Veterans Health Administration cohort.
Patients who underwent surgical resection for American Joint Committee on Cancer stages IB to III NSCLC between 2001 and 2011 were analyzed. Data regarding patient demographics and comorbidities, tumor characteristics, and primary treatment were collected. Patients were divided into 2 groups based on age at diagnosis: those aged <70 years and those aged ≥70 years. The primary exposure was use of adjuvant chemotherapy. A Cox proportional hazards model was used to estimate the significance of patient characteristics. Survival curves were estimated using the Kaplan-Meier method and group comparisons were performed using the log-rank test.
The analysis included 7593 patients who underwent surgical resection for stage IB to stage III NSCLC. Among these, 2897 patients (38%) were aged ≥70 years. The percentage of older patients who received adjuvant chemotherapy was approximately one-half that of younger patients who did so (15.3% vs 31.6%; P<.0001). Carboplatin-based doublets were used most often in all patients (64.6%). Both younger patients (hazard ratio, 0.79; 95% confidence interval, 0.72-0.86) and older patients (hazard ratio, 0.81; 95% confidence interval, 0.71-0.92) were found to have a lower risk of death with receipt of adjuvant chemotherapy.
Older patients derive a similar magnitude of benefit from adjuvant chemotherapy as younger patients and therefore adjuvant chemotherapy should not be withheld based on age alone.
手术切除后辅助化疗可改善早期非小细胞肺癌（NSCLC）患者的预后。据作者所知，目前尚无发表的前瞻性试验专门研究手术切除后辅助化疗在老年患者中的应用。在本研究中，作者旨在评估辅助化疗在退伍军人健康管理局队列中老年患者中的疗效。
分析了 2001 年至 2011 年间接受美国癌症联合委员会分期 IB 至 III 期 NSCLC 手术切除的患者。收集了患者人口统计学和合并症、肿瘤特征以及主要治疗的数据。根据诊断时的年龄将患者分为两组：年龄<70 岁和年龄≥70 岁。主要暴露因素是使用辅助化疗。采用 Cox 比例风险模型估计患者特征的显著性。使用 Kaplan-Meier 方法估计生存曲线，并使用对数秩检验进行组间比较。
该分析共纳入 7593 例接受 IB 期至 III 期 NSCLC 手术切除的患者。其中，2897 例（38%）患者年龄≥70 岁。接受辅助化疗的老年患者比例约为接受辅助化疗的年轻患者的一半（15.3%比 31.6%；P<.0001）。所有患者最常使用卡铂为基础的双药方案（64.6%）。年轻患者（风险比，0.79；95%置信区间，0.72-0.86）和老年患者（风险比，0.81；95%置信区间，0.71-0.92）接受辅助化疗后死亡风险均降低。
老年患者从辅助化疗中获益的程度与年轻患者相似，因此不应仅根据年龄拒绝辅助化疗。
