Higgins Kristin A, O'Connell Kelli, Liu Yuan, Gillespie Theresa W, McDonald Mark W, Pillai Rathi N, Patel Kirtesh R, Patel Pretesh R, Robinson Clifford G, Simone Charles B, Owonikoko Taofeek K, Belani Chandra P, Khuri Fadlo R, Curran Walter J, Ramalingam Suresh S, Behera Madhusmita
Department of Radiation Oncology, Emory University, Atlanta, Georgia; Winship Cancer Institute, Emory University, Atlanta, Georgia.
Rollins School of Public Health, Emory University, Atlanta, Georgia.
Int J Radiat Oncol Biol Phys. 2017 Jan 1;97(1):128-137. doi: 10.1016/j.ijrobp.2016.10.001. Epub 2016 Oct 11.
To analyze outcomes and predictors associated with proton radiation therapy for non-small cell lung cancer (NSCLC) in the National Cancer Database.
The National Cancer Database was queried to capture patients with stage I-IV NSCLC treated with thoracic radiation from 2004 to 2012. A logistic regression model was used to determine the predictors for utilization of proton radiation therapy. The univariate and multivariable association with overall survival were assessed by Cox proportional hazards models along with log-rank tests. A propensity score matching method was implemented to balance baseline covariates and eliminate selection bias.
A total of 243,822 patients (photon radiation therapy: 243,474; proton radiation therapy: 348) were included in the analysis. Patients in a ZIP code with a median income of <$46,000 per year were less likely to receive proton treatment, with the income cohort of $30,000 to $35,999 least likely to receive proton therapy (odds ratio 0.63 [95% confidence interval (CI) 0.44-0.90]; P=.011). On multivariate analysis of all patients, non-proton therapy was associated with significantly worse survival compared with proton therapy (hazard ratio 1.21 [95% CI 1.06-1.39]; P<.01). On propensity matched analysis, proton radiation therapy (n=309) was associated with better 5-year overall survival compared with non-proton radiation therapy (n=1549), 22% versus 16% (P=.025). For stage II and III patients, non-proton radiation therapy was associated with worse survival compared with proton radiation therapy (hazard ratio 1.35 [95% CI 1.10-1.64], P<.01).
Thoracic radiation with protons is associated with better survival in this retrospective analysis; further validation in the randomized setting is needed to account for any imbalances in patient characteristics, including positron emission tomography-computed tomography staging.
在国家癌症数据库中分析与非小细胞肺癌（NSCLC）质子放射治疗相关的结果及预测因素。
查询国家癌症数据库以获取2004年至2012年接受胸部放射治疗的I-IV期NSCLC患者。采用逻辑回归模型确定质子放射治疗使用的预测因素。通过Cox比例风险模型及对数秩检验评估与总生存期的单变量和多变量关联。采用倾向评分匹配方法平衡基线协变量并消除选择偏倚。
分析共纳入243,822例患者（光子放射治疗：243,474例；质子放射治疗：348例）。年收入中位数<$46,000的邮政编码区域的患者接受质子治疗的可能性较小，年收入在30,000美元至35,999美元的人群接受质子治疗的可能性最小（比值比0.63 [95%置信区间（CI）0.44 - 0.90]；P = 0.011）。对所有患者进行多变量分析时，与质子治疗相比，非质子治疗与显著更差的生存期相关（风险比1.21 [95% CI 1.06 - 1.39]；P < 0.01）。在倾向评分匹配分析中，与非质子放射治疗（n = 1549）相比，质子放射治疗（n = 309）与更好的5年总生存期相关，分别为22%和16%（P = 0.025）。对于II期和III期患者，与质子放射治疗相比，非质子放射治疗与更差的生存期相关（风险比1.35 [95% CI 1.10 - 1.64]，P < 0.01）。
在此回顾性分析中，质子胸部放射治疗与更好的生存期相关；需要在随机试验中进一步验证，以考虑患者特征的任何不平衡，包括正电子发射断层扫描 - 计算机断层扫描分期。
