Duggan K J, Descallar J, Vinod S K
South West Sydney & Sydney Local Health Districts Clinical Cancer Registry, Liverpool Hospital, Sydney, NSW, Australia; Ingham Institute for Applied Medical Research, Liverpool Hospital, Sydney, NSW, Australia.
Ingham Institute for Applied Medical Research, Liverpool Hospital, Sydney, NSW, Australia; South West Sydney Clinical School, University of New South Wales, Sydney, NSW, Australia.
Clin Oncol (R Coll Radiol). 2016 Oct;28(10):639-47. doi: 10.1016/j.clon.2016.04.045. Epub 2016 May 17.
The application of guideline recommended treatment (GRT) in routine clinical practice can be difficult due to differences between the clinic population and the clinical trial populations on which evidence is based. The study aims were to measure receipt of GRT in stage I-IIIB non-small cell lung cancer (NSCLC) patients, identify factors associated with GRT and its impact on survival.
New diagnoses of stage I-IIIB NSCLC from 1 January 2006 to 31 December 2011 in South West Sydney residents were identified from the district Clinical Cancer Registry. Treatment received was assigned as GRT or not based on Australian guidelines (using Eastern Cooperative Oncology Group [ECOG] performance status and TNM stage). Multivariate Poisson regression models with robust variance identified predictors of GRT receipt. Cox regression models identified multivariate predictors of patient survival.
In total, 592 eligible cases were identified, of whom 66% (n = 389) received GRT. This ranged from 81% of stage I to 39% of stage IIIB (relative risk 0.48, 0.38-0.60, P < 0.0001). Stage I-IIIA patients who were ECOG 2 and stage III patients aged 70 years and older were less likely to receive GRT. The median survival was 30 months in the GRT group and 16 months in the non-GRT group (P < 0.001). GRT receipt was associated with improved survival in stage I-II disease only (hazard ratio 0.41, P < 0.001; and hazard ratio 0.43, P = 0.006).
One-third of NSCLC patients did not receive GRT. Stage and performance status were key predictors for GRT receipt. Patients with early stage NSCLC were associated with improved survival with the receipt of GRT.
由于临床人群与证据所基于的临床试验人群存在差异，在常规临床实践中应用指南推荐治疗（GRT）可能会有困难。本研究的目的是衡量I-IIIB期非小细胞肺癌（NSCLC）患者接受GRT的情况，确定与GRT相关的因素及其对生存的影响。
从地区临床癌症登记处识别出2006年1月1日至2011年12月31日在悉尼西南部居民中首次诊断为I-IIIB期NSCLC的患者。根据澳大利亚指南（使用东部肿瘤协作组[ECOG]体能状态和TNM分期）将接受的治疗分为是否接受GRT。采用具有稳健方差的多变量泊松回归模型确定接受GRT的预测因素。Cox回归模型确定患者生存的多变量预测因素。
总共识别出592例符合条件的病例，其中66%（n = 389）接受了GRT。这一比例从I期的81%到IIIB期的39%不等（相对风险0.48，0.38 - 0.60，P < 0.0001）。ECOG 2级的I-IIIA期患者以及70岁及以上的III期患者接受GRT的可能性较小。GRT组的中位生存期为30个月，非GRT组为16个月（P < 0.001）。仅在I-II期疾病中，接受GRT与生存率提高相关（风险比0.41，P < 0.001；风险比0.43，P = 0.006）。
三分之一的NSCLC患者未接受GRT。分期和体能状态是接受GRT的关键预测因素。早期NSCLC患者接受GRT与生存率提高相关。
