Olszewski Adam J, Ali Shihab, Witherby Sabrina M
Department of Medicine, Alpert Medical School of Brown University Providence, RI, USA ; Division of Hematology-Oncology, Memorial Hospital of Rhode Island Pawtucket, RI, USA.
Department of Medicine, Alpert Medical School of Brown University Providence, RI, USA.
Am J Cancer Res. 2015 Jun 15;5(7):2229-40. eCollection 2015.
Erlotinib, bevacizumab, and pemetrexed improved survival of metastatic non-small cell lung cancer (mNSCLC) in clinical trials, but their benefits are restricted to non-squamous histology. We studied recent survival trends in mNSCLC subpopulations defined by histology and associated clinical factors correlating with adenocarcinoma or endothelial growth factor receptor mutations. Using the Surveillance, Epidemiology and End Results database, we calculated relative survival at 1 year from diagnosis for mNSCLC cases diagnosed in 2000-2011. Trends by histology, age, sex, race, prevalence of smoking or poverty, expressed as annual percent change (APC) using joinpoint regression, were compared by test of slope parallelism (Ppar ). Among 226,446 cases, 47% had adenocarcinoma, 20% squamous carcinoma, 6% other, and 27% unspecified histology. The proportion of cases designated as adenocarcinoma significantly increased after 2005. One-year survival increased from 23.5% in 2000 to 30.5% in 2010, significantly more for adenocarcinoma (APC, 3.3%) than squamous carcinoma (APC, 2.1%, Ppar =0.0018). For patients with adenocarcinoma, these trends were significantly better for Asians than Whites (Ppar =0.012) and for areas with fewer smokers (Ppar =0.014). Such differences were not observed for squamous carcinoma (Ppar =0.87 and 0.14, respectively). The absolute disparity in one-year survival between adenocarcinoma and squamous carcinoma increased from 1.6% in 2000 to 5.5% in 2010. The disparity between Asians and Whites increased from 5.2% to 13.1%, respectively. These data demonstrate that improvement in survival of mNSCLC since 2000 is now evident on a population scale. The superior increment for patients with adenocarcinoma, particularly among Asians and in communities with fewer smokers, suggests impact of the newly introduced, histology-specific agents, rather than better supportive care alone. Growing disparities between adenocarcinoma and squamous carcinoma highlight the needs to intensify research on treatment for subgroups that did not benefit from recent advances.
在临床试验中，厄洛替尼、贝伐单抗和培美曲塞可提高转移性非小细胞肺癌（mNSCLC）患者的生存率，但它们的益处仅限于非鳞状组织学类型。我们研究了根据组织学及与腺癌或内皮生长因子受体突变相关的临床因素所定义的mNSCLC亚群的近期生存趋势。利用监测、流行病学和最终结果数据库，我们计算了2000 - 2011年诊断的mNSCLC病例从诊断起1年的相对生存率。通过连接点回归以年度百分比变化（APC）表示的组织学、年龄、性别、种族、吸烟率或贫困率趋势，采用斜率平行性检验（Ppar）进行比较。在226,446例病例中，47%为腺癌，20%为鳞状细胞癌，6%为其他类型，27%组织学类型未明确。2005年后，诊断为腺癌的病例比例显著增加。1年生存率从2000年的23.5%提高到2010年的30.5%，腺癌患者的生存率提高幅度（APC为3.3%）显著高于鳞状细胞癌患者（APC为2.1%，Ppar = 0.0018）。对于腺癌患者，亚洲人的生存趋势显著优于白人（Ppar = 0.012），且在吸烟率较低地区的生存趋势也显著更优（Ppar = 0.014）。鳞状细胞癌患者未观察到此类差异（Ppar分别为0.87和0.14）。腺癌和鳞状细胞癌患者1年生存率的绝对差距从2000年的1.6%增加到2010年的5.5%。亚洲人和白人之间的差距分别从5.2%增加到13.1%。这些数据表明，自2000年以来mNSCLC患者生存率的提高在人群层面已很明显。腺癌患者生存率的显著提高，尤其是在亚洲人和吸烟率较低社区的患者中，表明新引入的组织学特异性药物产生了影响，而非仅仅是更好的支持治疗。腺癌和鳞状细胞癌之间日益扩大的差距凸显了加强对未从近期进展中获益的亚组治疗研究的必要性。
