Kaniski Filip, Enewold Lindsey, Thomas Anish, Malik Shakuntala, Stevens Jennifer L, Harlan Linda C
National Cancer Institute, Division of Cancer Control and Population Sciences, Healthcare Delivery Research Program, United States.
National Cancer Institute, Division of Cancer Control and Population Sciences, Healthcare Delivery Research Program, United States.
Lung Cancer. 2017 Jan;103:66-74. doi: 10.1016/j.lungcan.2016.11.020. Epub 2016 Nov 29.
Lung cancer remains a common and deadly cancer in the United States. This study evaluated factors associated with stage-specific cancer therapy and survival focusing on temporal trends and sociodemographic disparities.
A random sample (n=3,318) of non-small cell lung cancer (NSCLC) patients diagnosed in 1996, 2005 and 2010, and reported to the National Cancer Institute's Surveillance Epidemiology and End Results (SEER) program was analyzed. Logistic regression was utilized to identify factors associated with receipt of surgery among stage I/II patients and chemotherapy among stage IIIB/IV patients. Cox proportional hazard regression was utilized to assess factors associated with all-cause mortality, stratified by stage.
Surgery among stage I/II patients decreased non-significantly overtime (1996: 78.8%; 2010: 68.5%; p=0.18), whereas receipt of chemotherapy among stage IIIB/IV patients increased significantly overtime (1996: 36.1%; 2010: 51.2%; p<0.01). Receipt of surgery (70-79 and ≥80 vs. <70: Odds Ratio(OR):0.31; 95% Confidence Interval (CI): 0.16-0.63 and OR:0.04; 95% CI: 0.02-0.10, respectively) and chemotherapy (≥80 vs. <70: OR: 0.26; 95% CI:0.15-0.45) was less likely among older patients. Median survival improved non-significantly among stage I/II patients from 51 to 64 months (p=0.75) and significantly among IIIB/IV patients from 4 to 5 months (p<0.01).
Treatment disparities were observed in both stage groups, notably among older patients. Among stage I/II patients, survival did not change significantly possibly due to stable surgery utilization. Among stage IIIB/IV patients, although the use of chemotherapy increased and survival improved, the one-month increase in median survival highlights the need for addition research.
肺癌在美国仍然是一种常见且致命的癌症。本研究评估了与特定阶段癌症治疗及生存相关的因素，重点关注时间趋势和社会人口学差异。
分析了1996年、2005年和2010年诊断为非小细胞肺癌（NSCLC）并报告给美国国立癌症研究所监测、流行病学和最终结果（SEER）项目的随机样本（n = 3318）。采用逻辑回归确定I/II期患者接受手术以及IIIB/IV期患者接受化疗的相关因素。采用Cox比例风险回归评估按阶段分层的全因死亡率相关因素。
I/II期患者的手术率随时间略有下降但无统计学意义（1996年：78.8%；2010年：68.5%；p = 0.18），而IIIB/IV期患者接受化疗的比例随时间显著增加（1996年：36.1%；2010年：51.2%；p < 0.01）。年龄较大的患者接受手术（70 - 79岁和≥80岁组与<70岁组相比：优势比（OR）分别为0.31；95%置信区间（CI）：0.16 - 0.63和OR：0.04；95% CI：0.02 - 0.10）和化疗（≥80岁与<70岁组相比：OR：0.26；95% CI：0.15 - 0.45）的可能性较小。I/II期患者的中位生存期从51个月提高到64个月，无显著差异（p = 0.75），IIIB/IV期患者的中位生存期从4个月显著提高到5个月（p < 0.01）。
在两个阶段组中均观察到治疗差异，尤其是在老年患者中。在I/II期患者中，生存情况没有显著变化，可能是由于手术使用率稳定。在IIIB/IV期患者中，尽管化疗使用率增加且生存情况有所改善，但中位生存期仅增加1个月，这凸显了进一步研究的必要性。
