支付者状态对Ⅰ/Ⅱ期非小细胞肺癌患者生存的影响：国家癌症数据库1998 - 2011年数据

The Effect of Payer Status on Survival of Patients with Stage I/II Non-small Cell Lung Cancer: NCDB 1998-2011.

作者信息

Shi Runhua, Diaz Richie, Shi Zhenzhen, Duvall Elizabeth, Mills Glenn

机构信息

Department of Medicine & Feist-Weiller Cancer Center, LSU Health Shreveport, Shreveport, LA, U.S.A.

Weill Cornell Medical College, New York, NY, U.S.A.

出版信息

Anticancer Res. 2016 Jan;36(1):319-26.

PMID:26722060

Abstract

BACKGROUND

One of the challenges to improving access to care is identifying disparities in health care. To determine the influence of insurance status on outcome for patients with non-small cell lung cancer (NSCLC), we analyzed data from the National Cancer Data Base (NCDB) from 1998-2011.

MATERIALS AND METHODS

Data from 299,914 patients diagnosed with NSCLC registered in the NCDB were analyzed. Overall survival (OS) was the outcome variable, and payer status was the primary predictor variable. Other variables included stage, grade, lymph node status, age, race, Charlson Comorbidity Index, income, education, distance travelled, cancer program, diagnosing/treating facility, treatment delay, surgery, chemotherapy and radiation therapy. Multivariate Cox regression was used to investigate the effect of payer status on OS while adjusting for secondary predictive factors.

RESULTS

The majority of patients diagnosed at stage I-II had Medicare (61.72%), while less than one third were privately insured (29.57%). In univariate analysis, the median OS was 2.90, 3.42, 3.86, 4.19, and 6.23 years for Medicare, Medicaid, uninsured, unknown, and privately insured patients, respectively. Multivariate analysis revealed a statistically significant relationship between insurance status and OS. Interaction effects of treatment between radiation and surgery were statistically significant: patients receiving radiation in addition to surgery had a 37% increased mortality compared to patients undergoing surgery alone. Compared to receiving no treatment (radiation, surgery, chemotherapy), the 5-year direct adjusted survival probability increased by 44.70%, 40%, 3.91%, 9.42%, 31.56% and 33.20% for patients treated with surgery and chemotherapy, surgery alone, chemotherapy alone, radiation alone, radiation plus surgery, and radiation plus surgery and chemotherapy, respectively.

CONCLUSION

Insurance status proved to be a statistically significant predictor of OS, which remained true after adjusting for all other factors. Uninsured and Medicaid patients had the highest mortality. Multivariate analysis revealed that chemotherapy in addition to surgery provided the best 5-year direct adjusted survival probability.

摘要

背景

改善医疗服务可及性面临的挑战之一是识别医疗保健方面的差异。为了确定保险状况对非小细胞肺癌（NSCLC）患者预后的影响，我们分析了1998年至2011年国家癌症数据库（NCDB）的数据。

材料与方法

分析了NCDB中登记的299,914例诊断为NSCLC的患者的数据。总生存期（OS）是结果变量，支付者状态是主要预测变量。其他变量包括分期、分级、淋巴结状态、年龄、种族、查尔森合并症指数、收入、教育程度、就诊距离、癌症项目、诊断/治疗机构、治疗延迟、手术、化疗和放疗。多因素Cox回归用于研究支付者状态对OS的影响，同时对次要预测因素进行校正。

结果

大多数I-II期诊断的患者有医疗保险（61.72%），而不到三分之一为私人保险（29.57%）。单因素分析中，医疗保险、医疗补助、未参保、情况不明和私人保险患者的中位OS分别为2.90年、3.42年、3.86年、4.19年和6.23年。多因素分析显示保险状况与OS之间存在统计学显著关系。放疗与手术之间的治疗交互作用具有统计学显著性：与仅接受手术的患者相比，接受手术加放疗的患者死亡率增加37%。与未接受任何治疗（放疗、手术、化疗）相比，接受手术加化疗、单纯手术、单纯化疗、单纯放疗、放疗加手术以及放疗加手术和化疗的患者5年直接校正生存概率分别增加44.70%、40%、3.91%、9.42%、31.56%和33.20%。