Zhai Xiaoyu, Yang Lu, Chen Sipeng, Zheng Qiwen, Wang Ziping
Medical Oncology Department, Cancer Hospital, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing, 100021, China.
Department of Epidemiology and Health Statistics, Capital Medical University School of Public Health, Beijing, 100053, China.
Cancer Med. 2016 Sep;5(9):2286-93. doi: 10.1002/cam4.814. Epub 2016 Jul 1.
Adjuvant chemotherapy (ACT) after radical surgery is known to improve the survival of patients with non-small cell lung cancer (NSCLC). However, there are few studies reporting the impact of age on the efficacy of ACT in NSCLC patients. All patients who received postoperative ACT in the Cancer Hospital, the Chinese Academy of Medical Sciences, between 2001 and 2013 with complete records in the database of the hospital and met the inclusion criteria were enrolled in this study for analysis. The primary end point was disease-free survival (DFS) in terms of age. Survival analysis was performed using Kaplan-Meier estimates, log-rank tests, and Cox's proportional hazards regression analysis. Propensity score matching (PSM) was used, survival analysis and subgroup analysis of the match data were carried out. Of 1095 patients with stage IB to stage IIIA NSCLC who underwent radical resection, 865 cases who met the inclusion criteria were analyzed. Of them, 156 (18.0%) patients were 65 years old or older, and the remaining 709 (82.0%) patients were younger than 65. The DFS between the younger group and the elderly group was not significantly different neither before PSM (100.714 weeks [95% CI: 84.421, 117.007] vs. 99.571 weeks [95% CI: 82.621, 116.522]; P = 0.555) nor after PSM (104.857 weeks [95% CI: 81.495, 128.220] vs. 97.429 weeks [95% CI: 81.743, 113.114]; P = 0.328) using the Kaplan-Meier method.The results suggest that the benefit on DFS was similar regardless of age of NSCLC patients. ACT should not be withheld from elderly patients. However, these conclusions are limited by the nature of this retrospective study, and therefore prospective trials are required for further verification.
已知根治性手术后的辅助化疗(ACT)可提高非小细胞肺癌(NSCLC)患者的生存率。然而,很少有研究报道年龄对NSCLC患者ACT疗效的影响。2001年至2013年期间在中国医学科学院肿瘤医院接受术后ACT且医院数据库中有完整记录并符合纳入标准的所有患者均纳入本研究进行分析。主要终点是按年龄划分的无病生存期(DFS)。使用Kaplan-Meier估计、对数秩检验和Cox比例风险回归分析进行生存分析。采用倾向评分匹配(PSM),对匹配数据进行生存分析和亚组分析。在1095例接受根治性切除的IB期至IIIA期NSCLC患者中,分析了865例符合纳入标准的病例。其中,156例(18.0%)患者年龄在65岁及以上,其余709例(82.0%)患者年龄小于65岁。采用Kaplan-Meier方法,年轻组和老年组在PSM前的DFS无显著差异(100.714周[95%CI:84.421,117.007]对99.571周[95%CI:82.621,116.522];P = 0.555),PSM后也无显著差异(104.857周[95%CI:81.495,128.220]对97.429周[95%CI:81.743,113.114];P = 0.328)。结果表明,无论NSCLC患者年龄如何,其对DFS的获益相似。不应拒绝老年患者接受ACT。然而,这些结论受本回顾性研究性质的限制,因此需要进行前瞻性试验以进一步验证。