Eguchi Takashi, Bains Sarina, Lee Ming-Ching, Tan Kay See, Hristov Boris, Buitrago Daniel H, Bains Manjit S, Downey Robert J, Huang James, Isbell James M, Park Bernard J, Rusch Valerie W, Jones David R, Adusumilli Prasad S
All authors: Memorial Sloan Kettering Cancer Center, New York, NY; Takashi Eguchi, Shinshu University, Matsumoto, Japan; and Ming-Ching Lee, National Yang-Ming University, Taipei, Taiwan.
J Clin Oncol. 2017 Jan 20;35(3):281-290. doi: 10.1200/JCO.2016.69.0834. Epub 2016 Oct 31.
Purpose To perform competing risks analysis and determine short- and long-term cancer- and noncancer-specific mortality and morbidity in patients who had undergone resection for stage I non-small-cell lung cancer (NSCLC). Patients and Methods Of 5,371 consecutive patients who had undergone curative-intent resection of primary lung cancer at our institution (2000 to 2011), 2,186 with pathologic stage I NSCLC were included in the analysis. All preoperative clinical variables known to affect outcomes were included in the analysis, specifically, Charlson comorbidity index, predicted postoperative (ppo) diffusing capacity of the lung for carbon monoxide, and ppo forced expiratory volume in 1 second. Cause-specific mortality analysis was performed with competing risks analysis. Results Of 2,186 patients, 1,532 (70.1%) were ≥ 65 years of age, including 638 (29.2%) ≥ 75 years of age. In patients < 65, 65 to 74, and ≥ 75 years of age, 5-year lung cancer-specific cumulative incidence of death (CID) was 7.5%, 10.7%, and 13.2%, respectively (overall, 10.4%); noncancer-specific CID was 1.8%, 4.9%, and 9.0%, respectively (overall, 5.3%). In patients ≥ 65 years of age, for up to 2.5 years after resection, noncancer-specific CID was higher than lung cancer-specific CID; the higher noncancer-specific, early-phase mortality was enhanced in patients ≥ 75 years of age than in those 65 to 74 years of age. Multivariable analysis showed that low ppo diffusing capacity of lung for carbon monoxide was an independent predictor of severe morbidity ( P < .001), 1-year mortality ( P < .001), and noncancer-specific mortality ( P < .001), whereas low ppo forced expiratory volume in 1 second was an independent predictor of lung cancer-specific mortality ( P = .002). Conclusion In patients who undergo curative-intent resection of stage I NSCLC, noncancer-specific mortality is a significant competing event, with an increasing impact as patient age increases.
目的 进行竞争风险分析，并确定接受I期非小细胞肺癌（NSCLC）切除术患者的短期和长期癌症特异性及非癌症特异性死亡率和发病率。患者与方法 在我院（2000年至2011年）连续接受原发性肺癌根治性切除术的5371例患者中，2186例病理分期为I期NSCLC的患者纳入分析。分析中纳入了所有已知会影响预后的术前临床变量，具体包括Charlson合并症指数、预测术后（ppo）肺一氧化碳弥散量以及ppo 1秒用力呼气量。采用竞争风险分析进行病因特异性死亡率分析。结果 2186例患者中，1532例（70.1%）年龄≥65岁，其中638例（29.2%）年龄≥75岁。年龄<65岁、65至74岁和≥75岁的患者中，5年肺癌特异性累积死亡发生率（CID）分别为7.5%、10.7%和13.2%（总体为10.4%）；非癌症特异性CID分别为1.8%、4.9%和9.0%（总体为5.3%）。在≥65岁的患者中，术后长达2.5年，非癌症特异性CID高于肺癌特异性CID；≥75岁患者的非癌症特异性早期死亡率高于65至74岁患者。多变量分析显示，低ppo肺一氧化碳弥散量是严重发病率（P<.001）、1年死亡率（P<.001）和非癌症特异性死亡率（P<.001）的独立预测因素，而低ppo 1秒用力呼气量是肺癌特异性死亡率的独立预测因素（P=.002）。结论 在接受I期NSCLC根治性切除术的患者中，非癌症特异性死亡率是一个重要的竞争事件，且随着患者年龄增加影响越来越大。
